13 hours ago
Thursday, July 30, 2009
Fighting the insurance company: na-na-na-na-na, I won!
It's been almost two years since I launched a war against our insurance company to get them to pay for speech treatment/dysphagia therapy for Max (it's a condition in which someone has difficulty swallowing). I've spent countless hours writing letters, making phone calls, photocopying, writing more letters and getting Max's therapists and doctors to write letters explaining why he needed therapy.
I was never going to give up. But when the insurance company denied our second appeal on the grounds, they said, that Max did not have dysphagia, I erupted like Mount Vesuvius.
Max has issues swallowing food that's not soft or mashed up. He chokes on water sometimes. He's in danger of aspirating, if we're not careful.
And so, I got the neurologist to write a letter stating that Max had dysphagia and explaining why it was a life-threatening condition. The two speech therapists did the same. The pediatrician's office sent growth charts showing how Max had fallen off them because of the eating issues he has. Sobering letters, but the proof we needed. Oh, and then I sent a strongly-worded letter pointing out that their statement that Max did not have dysphagia was patently wrong. And yeah, I used the "l" word: lawyer. As in, I would get one.
The insurance company sent the appeal for external review.
WE WON. They will pay for past dysphagia therapies and new ones going forward.
A few things I learned along the way:
• If you or your child have any sort of ongoing condition, ask to be assigned to one bill processor or rep who you can dial directly. This is so much easier (and eminently less frustrating) than getting caught up in the "IF YOU ARE HUMAN, PRESS 1 NOW!" automated phone system every time you call.
• Also find a manager at the company you can reach out to as necessary.
• Keep notes on every single phone call you make; ask for the person's name, department and any other identifying info.
• If you're getting nowhere—or getting the run-around—ask someone in your benefits department to reach out to your company's insurance rep.
• Ask your child's therapists for clues. They know what's helped other parents fight insurance companies, they know what therapy codes make it through and what don't and they can suggest wording to use in a letter.
• Insurance companies might count on you to give up/go away/expire of natural causes. But as a nice bill processor once told me, "The squeaky wheel gets oiled."
Photo by Pewari Naan
Posted by Ellen Seidman at 12:35 AM