The Today Show this morning featured a vignette about what to do if you are denied a treatment or therapy by your health insurance company — the steps you can take to, perhaps, change their mind.
Yeah, right. Like that might happen.
The story featured a woman who is dying of a rare form of lung cancer. The point made by the representative of her health insurance company was that they only provide coverage for treatments and therapies approved by the FDA. In the woman’s case, the treatment her doctor recommended wasn’t approved by the FDA.
Never mind that the woman is dying, and that particular treatment might be her last chance for survival.
Never mind that she has been paying into health insurance for her entire career and now when she needs them to handle their part of the patient support agreement, they are backing down.
Never mind that she has two choices: she can forget the treatment and die, or she can pay for the treatment herself — $50,000 per year — and have no money left for anything else, and perhaps end up in bankruptcy if it actually is a successful treatment for her.
As I’ve written before, there are dozens if not hundreds of off-label uses for drugs that are prescribed every day, Most are paid for by insurance. So — sorry — that seems like a weak argument to me.
We have to remember that the reason the health insurance companies exist is not to help us pay for healthcare at all. No — they exist to make a profit. Yes, even the non-profits are there to make more money, even if they have ways of hiding the income so they can continue to call themselves non-profit. If you saw Sicko, then you know that these companies employ people who do nothing but research someone’s past to enable the company to deny a claim. And you know that any time a claim is paid out, it is called a “loss.”
Don’t forget — it’s not about health or care — it’s about sickness and money. I’ll stick by previous claims that the perfect scenario for an insurance company is to get you to pay in and pay in and pay in until you actually need them to pay for something. Then they would just as soon you die quickly from whatever it is you get so they won’t have to keep paying for it.
However, time for me to stand down from my pulpit and get back to what’s really important — helping you, my patient-readers, help yourselves through the health insurance quagmire….
The ideas proferred this morning were most definitely a step in the right direction. They come from Michelle Katz who has written a book, 101 Health Insurance Tips, about how to manage health insurance denials. I hope these can help you:
- Check to see if there has been a coding error on your records. Sometimes your denial might come from a simple coding error and its correction may get you the approval you need.
- Start appealing as soon as possible because you may have a time limit from the first rejection to carry out an appeal. Make sure you have copies of everything — all records, paperwork to help you appeal.
- Check in with your HR department. They may help you get through the process.
- Talk to your doctor about your denial. Since s/he will be denied the payment, too, s/he has a reason to help you get it approved.
- If you don’t have the luxury of time, then get your doctor involved immediately to help.
- Alert the watchdogs. Each state has its own insurance commissioner – contact that person. Also talk to your state’s attorney general. A last ditch effort might come through an attorney.
Do you have more ideas? I’d love to hear them. Please contact me — I’ll add them, along with your name if you’d like — to my blog.
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