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10 ways to deal with insurance companies without pulling your face off

July 7, 2015 | Posted in: insurance companies

  1. Be persistent. (Annoyingly so) For our purposes today, the insurance company is “the man.” He is not here to help you get the care that you desperately need but to make money. So naturally, “the man” is hoping that you will get tired of fighting and give up. You can’t. You have to keep calling, keep writing, keep appealing, and keep seeking the treatment that you need until you get it. The man isn’t always just going to give it to you just because you need it. Remember, it’s that money thing.
  2. Document everything. My husband often makes the calls and writes the letters to the man on my behalf. And when he does he makes sure to ask, “I’m sorry what did you say your name was again?” If he’s calling about a pre-authorized procedure that they decided not to pay for and have now sent a bill for (as he often is) he writes the date and time of each call on the bill along with the name of the person that he spoke with. I chuckle to myself when I hear him say, “Well, when I spoke with Sally in member appeals on the 11th she said she would have this resolved by the 20th, but I received another bill in the mail today and Sally hasn’t returned any of my calls since then. He’s no amateur.
  3. Pray. Pray that you don’t lose your salvation while speaking to the man. Pray that someone in your home has the good sense to hide all of the sharp objects. Pray that no one cuts you off in traffic and incurs that wrath intended for the man. Pray for favor. Just pray.
  4. Contact the Patient Advocate Foundation. This amazing non-profit organization will help you with everything from getting pre-authorization, coding and billing to assigning a case manager for appeals. http://www.patientadvocate.org/index.php?p=757
  5. Try another doctor. If your doctor has prescribed a treatment that the man is refusing to pay for, try getting another doctor to prescribe it. Sometimes seeing that multiple doctors are in agreement can give your case more credibility. Also, some doctors are more aware of the “tricks of the trade” in terms of how to get things approved. The slightest change in wording or additional bloodwork might make all the difference.
  6. Jump through the hoops. You may need to repeat step three before you do this. If you are like me, this can be infuriating. Maybe you pay a tremendous amount of money for insurance, only for the man to cut you off when you really need him. Why should you have to jump through his hoops? The bottom line is, jumping through the hoops will move things along faster. Once you can say you’ve been there, done that and bought the t-shirt, the sooner you can say, next!
  7. Request external reviews. These can actually occur at the same time as the internal reviews, allowing you to kill two birds with one stone. So let’s say that you desperately need a treatment the man won’t approve. Or you’ve already had the treatment and now the man is convinced you did it just for good time’s sake and you didn’t really need it. You can request the appeal and the external review at the same time. In some instances, you can request that the external review be expedited.
  8. Always try a “peer to peer” review. I was recently denied a treatment from my insurance company for an immune condition by their pulmonary doctor. That’s right, their lung doctor made a decision about my immune treatment. Unfortunately, many of these doctors, are trained to say no and may not even fully understand the condition they are making a decision about. You WANT your doctor on the phone with the man’s doctor explaining it.
  9. Get direct lines and contact names. “And who’s attention should I send that to?” is my favorite question. Otherwise, the man is going to play the “I’m sorry we never received those clinicals, game with me all year long. I want a direct line, with a name. And you better bet I’m going to be staring at that fax confirmation sheet with your direct line and name on it when you tell me that you never received it. I’m no amateur.
  10. Yell at them. I know, this doesn’t sound very nice. It goes against everything you ever learned in Sunday school. I am not saying use every foul word you’ve ever seen written on the back of a bathroom door. I’m saying, let them know you mean business. Tell the man you will not be going away. I’ve been fighting for IV IG for almost seven months now. My doctor was finally able to get it approved after the “peer to peer” review. His words of wisdom after an hour on the phone with them? “Sometimes you just have to yell at them.” And there you have it.

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