Dealing With (Insurance) Denial

Every year seems to start up a new game with my health insurance company. If they do not send out a new statement of benefits, I have to track it down on their website or call in to request a copy. Depending upon the new government regulations, new treatments (finally) considered scientifically viable, and the general shifts of the medical industry, premiums will go up and coverage will change.

This year, I seem to have hit nearly every snag possible with my health insurance. Increased premiums, claim denials based on semantics, lack of interdepartmental communication freezing appeals, misfiled paperwork, and even dropped coverage without notice during a hospital stay,,, I feel as though I have seen it all! And I’m not the only one.

So many friends have complained about the state of healthcare in the United States, and often the complaints center around the functionality (or lack thereof) of the health insurance industry. While I have not extensively studied healthcare solutions, I do understand the need for reform. More importantly, I understand the need for more personal assistance.

From the perspective of the individual, health insurance and the companies who provide it can be daunting. Speaking to a customer service representative does not guarantee they can explain what is on your account. Nor does speaking with your doctor’s billing department guarantee they know what is on your insurance account. Just today, I spent quite a bit of time relaying information between my doctor’s office and my insurance company, only to discover that neither side had a clear idea of what the insurance filers were looking for on my claim and appeal. Yet that’s a step farther from my previous insurance company who refused to speak with me because my policy was through an employer!

The institutional and bureaucratic failings of health insurance companies appear vast. While the fight in Congress continues, the larger reforms are not currently helping the individual make sense of it all. They are not helping me understand my company, nor are they helping me submit claims. More importantly, they are not offering me peace of mind each night as I go to sleep with a five-digit number gnawing at the back of my brain because my mainstream rheumatoid arthritis treatment was not deemed “medically necessary.” So that got me thinking…

What can I do next?

To a big insurance company, I am just another drain of money. To my doctors, I am a patient who cannot pay, and sympathy does not make up for thousands of dollars owed. To my family, I am a loved one they wish they could help. And to myself, I am one big, jumbled mess!

In order to keep from curling up in a ball and wasting away, I have found that even the biggest messes are manageable with a plan. So I have set out a few potential ways to get help when your current insurance company is just not following through.

Plan B (Or C, or D…): What options do you have when your current insurance falls through?

  1. Go up the ladder: Customer service representatives can only see and understand so much about your account. Ask to speak with a supervisor, and be polite! I cannot tell you how much more smoothly these conversations go when you are calm and cordial. Remember, they are there to help, and usually they will try to help as much as they can.
  2. Talk with your doctor/pharmaceutical company: Your doctor’s staff will often know a few ways to get financial assistance. For example, several medications have financing programs to help people in need. The RA treatment I receive, Remicade, has a patient rebate program called RemiStart that helps lower the cost of treatments for those who have insurance willing to pay a portion of the cost. Speak up, ask questions, and figure out if there is a financial assistance program you can use.
  3. Shop around: Maybe the plan you have isn’t the best one for you. Go online or speak with customer service to request a copy of your benefits package. Talk to your friends about their coverage, discuss plans with your HR department, and even talk to the billing department at your doctor’s office to see if they have any suggestions. Health insurance policies are not one-size-fits-all. Talking about your personal predicament with someone else who better understands the plans can be a great help.
  4. Consider getting secondary insurance: Even when you have a primary provider who will pay some of your medical bills, the out-of-pocket expenses can still be painful. The trade-off is another monthly insurance fee, but the benefits of secondary insurance may outweigh that. Search online or ask friends about their plans to see if secondary insurance at another company might be a better option.
  5. Raise funds through crowdsourcingThis is a newer option I have seen popping up on social media sites and email chains. Companies like Give Forward allow you to create a page where friends, family, and strangers can donate to your cause or offer words of encouragement. These sites do take a processing fee from each donation, but might be an option to help collect from your friends and family who want to give.
  6. Reach out to loved ones for emotional support: This one just might be the most important. We often get so bogged down in the cost of care that we forget to appreciate the care we have. Family and friends can help us carry those burdens and remind us that the rough patches make for stronger relationships and greater life fulfillment.

At the end of the day, dealing with insurance companies is frustrating, and it gets worse each time they deny a claim. So take a step back, look at your options, and make a plan.

Please feel free to leave insurance tips in the comments section!

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