Insurance

My first introduction to the world of insurance was as a personal injury attorney.  I will forever be offended by the term “ambulance chaser” since that was never part of my experience as a lawyer representing people who were genuinely harmed in a variety of ways, but that is the stereotype.

During my tenure as a personal injury attorney (and I did represent some insurance companies as well as plaintiffs), I learned to truly distrust insurance companies.  While I am well aware that many people are not fully honest about many things, struggling to get funds for genuinely injured people who were adversely affected in the most significant ways has forever tainted the way I look at insurance companies.

Yet, I bought a lot of insurance.  I suppose that is somewhat inconsistent, but I also saw how many people are under-insured on a daily basis for years.  My husband was always more skeptical than I about insurance and my desire to purchase so much of it, but we’ve also seen some big upsides now that I am no longer working.

I now deal with my health insurance company nearly daily.  I don’t want to, but the outcome of having a terminal illness is that I see doctors and other medical providers at least weekly and sometimes more than that.   It’s ironic to me that I am not considered to be in “active treatment,” but I still see my medical team more than I’ve ever seen doctors before my diagnosis.

There are a few things I’ve learned along the way about dealing with health insurance companies in the midst of a terminal illness and here are a few items of note in no particular order …

  1. Find out what requires an authorization in advance.  This widely varies by insurance company and plan and is extremely important to know.  Most of the time a pre-authorization carries with it a tracking number.  Get that.
  2. Don’t take anyone’s word for anything.  Another way of saying this is trust, but verify.  This is particularly important when it comes to pre-authorizations.  An example — my health insurance company requires a pre-authorization for PET scans.  It says so on the back of my card.  I pointed this out multiple times to my former hospital.  When I arrived for my PET scan, I was told that a pre-authorization was obtained.  It turned out that someone called an automated line, entered my insurance policy number and “heard” a recording that a pre-authorization was not required.  This was not the case.  I didn’t know any of this until I received a substantial bill in the mail a few months later.  Now, I didn’t pay that bill (probably the subject of another blog post), but dealing with the insanity of talking to a hospital trying to collect funds and an insurance company trying to avoid paying is draining and takes so much time away from my family, so now I verify and verify and verify.
  3. Know what your plan covers and when.  An insurance contract is likely hundreds of pages long; however, when you have a specific terminal diagnosis, there is likely a smaller amount of language specifically applicable regularly.  Every time I encounter a situation where my insurance company does not want to pay, I go back to the contract language and make sure I’m on good footing when I call. An example–my contract requires that if my doctor has to appeal a decision, the insurance company must provide a peer.  When my insurance company has a doctor without credentials demonstrating that that doctor is my doctor’s peer, I found out that I can require a second peer to peer consult with an actual peer.  My doctor’s office was not aware of this–I found out because I didn’t stop asking why the request for a PET scan was denied.  It hasn’t been denied again.
  4. Don’t be afraid to ask for a supervisor or a supervisor’s supervisor.  I’ve found that I often don’t get what I need by talking to the first group of people who answer the phone.  Most of them give me contradictory answers and/or have no idea how to apply my policy to the situations I encounter.  I get that my situation is more complicated because I am both terminal and am receiving curative care.  So when I don’t get the information or the answer I need, I simply ask for someone else.
  5. Write down names, details, dates and times.  I’m a bit obsessive about this.  I have notebooks full of data that I don’t need and likely won’t ever need; however, this information has saved me several times.  That first group of people who answer the phone at my insurance company and many individuals within my cancer center have often written “notes” that are not accurate.  I’m thankful that most of the time these conversations are recorded, but I am not happy that I often have to point out to supervisors that their subordinates actually lied to make themselves look better.
  6. An insurance executive suggested a letter to the President of the company to address larger concerns.  I attended a conference last summer where an insurance executive made the case that insurance companies are full of people who care about their policyholders and are trying to figure out a way to pay for the treatment we need.  I don’t think any of the patients in the audience actually agreed with him, but one thing he suggested that definitely resonated with me was to write a letter to the President of the health insurance company if there is a systemic issue.  I believe he also wanted to impart that the executives at the top of the food chain simply don’t have much patient contact, so if a patient/insured can get the attention of the executives, then the executives circulate the letter and that gets something done.  I’ve not tried this yet, but I’m keeping it in my back pocket for when I need it.
  7. Companies, generally, are responsive to negative reviews or comments/posts on social media.  I’ve noticed that Twitter is the most productive for publicly shaming companies.  I’m also now connected to a lot of people who work for insurance companies on both LinkedIn and Twitter.  Not only do I want to make sure that I am a credible person to bring up an issue, but I want to know who I might need to communicate with if there is a big issue that needs to be dealt with on a larger scale.

I’m sure I will come up with more suggestions/comments the further I get into the health care world/system.  It is a place where I certainly don’t want to be, but since I’m here, I might as well understand it as much as possible.

Author: Abigail Johnston

I'm a daughter, a wife, a mother, and I've been living with Stage IV Metastatic Breast Cancer since March, 2017. All of the words I publish are my own.

4 thoughts on “Insurance”

  1. Omg, amen to ALL of this! I’m wondering when I would have time to work if in remission for my disease because to STAY in remission, requires constant phone calls hours long with the insurance company and at the pharmacy, and I have an AMAZING pharmacy!

    When anybody tries to blame anything on my pharmacist, I call them on three-way. After I’ve already called them out on the spot and said it is not the pharmacist! I have watched them for HOURS trying to call doctors and insurance companies to get authorization to give me medications and have them give me emergency medication to get through the weekend. IT IS THE INSURANCE EVERY TIME! One doctor I have refuses to do pre-authorizations. I can’t say that I blame him. Isn’t that what a prescription is, after all?!

    And I’m just talking about medications. Never mind other procedures like finding out what doctors are covered under what insurance. I get severe anxiety now every time I have to deal with anything medical.

    I feel like this HAS to stop. Our doctors are having to stop trying to find cures and take care of us and keep us alive so they can authorize medications that they have already deemed necessary when writing a prescription after a referral for their expertise was made to them in the first place. What is that!?

    Ok, I’m done. Thank you for this post. I needed it today, even though I got lucky today with a med I expected to have a 2 hour-2 day problem with. Yay! 🥳

    Liked by 1 person

  2. I also feel very fortunate that I have the mental ability and the skills to be able to navigate the system, somewhat, for now. I feel really sorry for the people who may not know how to accomplish half of what you’re talking about. That breaks my heart daily as I fight them. What is happening to those who don’t know how to fight?! Or the ones who do, but get disheartened and so depressed and give up? As I do periodically, and luckily, have either pulled myself out of it or had someone to help pull me out. No doubt I have had angels along the way all my life. I hope the same is true for those less fortunate than I am.

    I help when I can. Becsuse when you’ve been there, how can you not?

    Liked by 1 person

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