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?
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5 Comments
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Dear Alex,
Thank you very much for your thoughtful comments on the Parade article. Articles such as the Parade piece serve a propaganda function. We citizens of the empire are just supposed to accept the lack of health care, even though every other major industrialized nation offers it to their citizens. The article should have asked why this is so. Health Care is a concern for every person in this country. It should be a right.
As a relatively healthy, HIV negative gay man in my early forties, I didn't think that I'd face any major health crisis until I was in my 60's, at the earliest. Well, surprise, surprise, I was diagnosed with a rare form of Leukemia on June, 28, 2007.
I was one of the lucky ones, as my job offered me good health benefits. Still, the chemotherapy and subsequent infection I caught left me debilitated and out of work for three months. I had to enlist the aid of my mother to handle all of my insurance issues. I was really too ill to even submit forms to insurance, let alone, file the occasional appeal.
By the way, I also had private disability insurance. I’m glad I had it, but it took three months before I got my first check. They put me through hell. They were rude. My bills were overdue. That is why I paid for private disability in the first place. They had no problem taking my premiums, but when it was time for them to pay up, they dragged their feet and treated me poorly. Now, I am saving so that I have a cushion to carry me through the next time I need chemotherapy.
My best friend of twenty years Catherine did not have health insurance last year when she found out her breast cancer had returned. She had to wait six months for NJ charity care to kick in before she could get a double mastectomy, even though she was being consumed by stage 3B breast cancer. Oh, and she had to pay the surgeon before he would operate. Her widowed mother, who works part time to support herself, had to cash out a small savings account. Catherine herself was gainfully employed for the last seven years a research scientist for a pharmaceutical firm, who would only hire her as contractor. Therefore, she didn't have insurance, despite playing by the ostensible "rules" (getting the college degree and working in her field).
Anyway, thanks again for the critique of the Parade article. I believe that there is a good chance I'd be dead if I didn't have health insurance.
Vincent Fischer | January 23, 2008 9:32 PM
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It's this possibility, Vincent, that is so heartbreaking.
And thank you, Alex, for another thought provoking post on the issue!
R | January 24, 2008 12:43 AM
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Alex, super post.
The average monthly cost of the Texas oil piracy in Iraq is $9 billion dollars. That’s $522 billions dollars to date plus the billions stolen by Blackwater USA, Bechtel, Haliburton et al. That money has been used to kill 650,000 Iraqis. It could’ve paid for every medical cost imaginable, built schools, colleges, and decent housing and repaired the nation’s infrastructure.
The Democrats and Republicans who matter support the war and oppose socialized medicine. They’re jointly responsible for the deregulation and union busting (unions’ equal decent wages and adequate buying power) that are driving an economic tail spin. Even Republican economist Martin Feldstein says that the recession “could be a long, deep, severe one.” Hoover, strike that, I mean Bush, today requested an emergency $145 billion economic stimulus package. (If you start hearing terms like ‘crisis of liquidity’ and ‘fictitious capital” that will be a signal to buy an economic life jacket.)
The cause of the accelerating economic downturn is easy to spot. In the 1970’s the richest 1% owned almost 20% of US wealth. Today they own 40%, a concentration of wealth last seen in 1929, a somewhat noteworthy date in US economic history. By contrast working people, small business owners and framers constitute 85% of the population and we share among ourselves 15% of the wealth. (The top 20%, gazillionaires, billionaires and chump change millionaires share 85% of the wealth.)
Soon after the 2008 elections two major political trends will slowly begin to intersect, both centered on the war, bigotry and the economic downturn. First, the Democrats and Republicans won’t be capable of solving them and secondly, millions of Americans are going to pass from anger to activism. GLBT folk will be among the first to react.
The chickens are coming home to roost, and they’ve got teeth.
Bill Perdue | January 24, 2008 1:59 AM
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You have to admit, while the topic for the article is enough to drive us crazy, the underlying point of the piece is sound. Americans, sadly, do have to know how to circumvent the horrible system that is our health care system.
When I needed medical care I had no insurance. Since my illness isn't something you can treat in an emergency room, I was shit out of luck. I had to wait 6 months to get in via charity care since my job didn't include insurance.
I loved my last job's "insurance." When it came to mental health, they'd pay for you to see a therapist 4 times a year. Yup. 4. That's helpful, eh?
Bil Browning | January 24, 2008 8:14 AM
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I don't think that anyone was saying that the article is factually incorrect, just that there it's a sign of a pretty bad system when the Parade is telling people they have to do an immense amount of work to fight a multi-billion dollar industry to get something they've already paid for.
Alex Blaze | January 24, 2008 8:29 AM
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