If you’ve ever dealt with a long term illness, chances are high that you have had to tackle insurance coverage issues. If you are living in the United States, chances are even higher that your company has refused to pay for something.
Navigating insurance coverage can be frustrating to say the least, especially when you don’t feel well. Even more aggravating is when the coverage rules change mid-term. It’s easy to spend hours on hold or transferred to various departments only to end up with nothing but despair and disappointment.
I totally understand because I’ve spent over a decade working with insurance companies due to medical bills for my own health issues.
When it comes to insurance payment, I’ve been denied coverage countless times and I’ve finally figured out why…It’s their job to not pay. I’m not saying that they are deliberately trying to make our life miserable (although sometimes I thing that is the case), but what they are doing is trying to manage high cost patients like those of us with chronic illness to keep their expenses down.
Our job as patients is to be our own advocates and fight for the life saving treatments we need, and get them covered by our insurance company. This can seem overwhelming at times, and it’s easy to give up.
Here’s the good news.[clickToTweet tweet=” After years of struggling with insurance coverage and payment, I’ve finally figured it out.” quote=” After years of struggling with insurance coverage and payment, I’ve finally figured it out.”] With a lot of patience, and little organization it is absolutely possible to get approval for more than you think, especially if you have a PPO.
I’ve developed a system to get payment for medical bills with less stress. Here are a few tips and a free printable checklist to help you:
- Get organized – Make sure you keep a file of all your bills and what you have paid. I’ve been re-billed multiple times for charges I’ve already paid that were up to five years old. If I didn’t have proof, I would have been responsible to pay again. And again.
- Start with a smile in your voice – It’s human nature to respond according to how we are treated. If you start out angry, you will be doing yourself a disservice. Going in with an attitude of, “How have we get this matter resolved so I can…”, changes the energy and the receiver will be much more responsive. I typically start my conversation with, “I need to get this covered. What do you need to make that happen?” It’s more constructive for everyone.
- Block out your time when calling your insurance company – Know that you are probably going to be on the phone for awhile so get comfortable.
- When getting transferred to another Insurance representative, make sure the last one stays on the line with you until you know you are in the right place – This little step has saved me hours of time. I can’t tell you how many times I will be talking with someone, get to where I need to go, and the call drops and I have to start over. Or, they send me to the wrong place and that person transfers me back to the beginning.
- If you get an answer you need, make sure that person documents it in your file and ask them to read it back to you – They say they will notate but it never happens.
- Make sure your doctor is taking very detailed notes on your condition and what his recommendations are for protocol – Many times insurance companies will ask to see your notes, the more involved they are, the better for you. My neurologist has had to explain to my insurance company’s medical director, a pediatrician, the particulars of my disease and the protocol. Without his notes in great detail, I probably would have been denied coverage. Don’t forget to let him know if when you’re feeling unwell or if something is working well. Document everything and bring it with you to your next appointment. Better to have too much then too little.
- Don’t give up – I can’t tell you how many times I’ve been denied something by my insurance company then called back the next day and got what I needed. When Obamacare was enforced, insurance companies had to hire hundreds of people to keep up with demand. They weren’t all trained very well unfortunately. If you don’t like what you are hearing from them, thank the spokesperson then try again tomorrow.
- If your rights are being denied, get your state representative involved – When my drugs were reclassified, which is a common insurance practice, I called my legislator and got them involved. They, in turn, contacted the State Board of Insurance and went after the company on my behalf. It’s part of their job to make sure we are protected. Don’t be afraid to ask. It’s also free.
- Don’t suffer, get the help you need – I’m functioning based on a balanced medical and complementary protocol. When that balance is upset by treatment interruptions, things start going south. If you are suffering because you have been denied a needed medical treatment or procedure, go to the emergency room and get it. You insurance has to pay for it then and it is also good documentation for why you need it in the first place.
- Have patience – Getting what you need can take time. Make sure you are feeling well, and rested before you pick up the phone. Go in with an attitude that you and your insurance company will figure this out but it may take a moment. It’s taken me up to three months to get something I need. You will get there, just know if may take a minute. Don’t give up on the first try and make sure you are in for the long game.
Chronic illness is hard enough. Getting your medical cost covered shouldn’t be a hassle but unfortunately, it is. I’ve made a checklist for you to download of these and more tips to make dealing with insurance as painless as possible. Click the link below and it will be in your email box in a matter of minutes.