Parade Magazine, that Sunday insert famous for celeb gossip, exclusive photo-shoots with the hottest reality TV stars, and Marilyn vos Savant's logic games column, had an article this past Sunday about how to fight your health insurance company.
Denial of legitimate health care claims is so ubiquitous, apparently, that even Parade has realized it has to rally its readers to fight the system.
The article opens with:
Chances are, if you're among those Americans lucky enough to have health insurance, you will eventually have a claim rejected.
Haha, you didn't think that you would actually get what you're entitled to, did you? Because part of the American experience with health care is to get your claims denied. The article continues:
And even if that decision appears arbitrary and unfair, you, like many of us, may just roll over and accept the verdict. Fighting the health-insurance bureaucracy on even small matters can be draining. And winning seems like such a long shot.
But that really isn’t true. Surprisingly, people who fight back when their health-care provider says “no” often do win. The keys are knowing what will get results and being persistent.
Because that's what everyone wants to do while recovering from disease - fight a multi-million or billion dollar corporation for something to which they're already entitled.
The steps to getting your claim through start with reading up on your policy, state, and federal law to know the exact laws and policies that show that your claim should have been accepted. After that, call the company with all of your evidence and keep records of everything they say for your own records.
Bet you didn't know you had to become a lawyer!
When that doesn't work, file a written appeal. Of course, for that written appeal, you'll need all your medical information and be ready to prove that the treatment was necessary, why other treatments failed, and that your procedure is "medically accepted." You're probably going to have to head down to your library and crack open the medical journals for this step, because your doctors obviously didn't know what they were thinking.
Bet you didn't know you had to become a doctor!
When that fails, the article suggests contacting an advocacy group that works in the area of your condition and asking for an independent review. Forty-three states have their own claims review boards set up and decide in favor of patients a surprisingly frequently - 50% of the time. But almost no one uses them since they don't know they exist (and maybe there's the whole being sick part, and the fact that this all has to be done in 6 months).
Bet you didn't know you had to become an activist!
Make sure you keep on making your monthly payments to the insurance company throughout this ordeal (not in the Parade article). They're allowed to deny you money that you're entitled to, not the other way around. Don't you know your place?
And we still can't even get Hillary, Barack, or John to back single payer health care. This is probably why Hillary's "I've been fighting for you for decades", Obama's transcendental politics, and Edwards's two Americas rhetoric all ring a little hollow to me.
I know that part of being American is irrationally hating the government, but shouldn't situations like this make us justifiably angry with private enterprise? Isn't this an issue where someone could back single-payer and still win? Isn't the fact that we need to be experts in law and medicine to get claims through absolutely ridiculous?