Monday, December 5, 2011

Insurance.....May Not Be Our Friend

Unfortunately we are all strapped by insurance when it comes to our health.  Dealing with insurance can be a good experience (when they pay) but many times it can be a bad experience.  Many, many times insurance companies will decline your claim assuming (and hoping) that you will just pay it and move on.  However, a lot of times if you fight it, you can overturn it.  The problem is that it takes lots of time and energy.  Most of what has been already taken from you dealing with your loved ones stroke or other medical issues.  Who has the energy to fight insurance companies after what all you have been through?

I went to a conference this weekend given by a Speech Pathologist who fights many insurance claims for her clients.  Sometimes it takes several appeals before it is overturned, which in turn may be several months.  She told a story of how one insurance representative she spoke to continued to tell her that the speech therapy services were not covered for her patient.  But then at the END of the conversation the employee proceeded to ask her, "by the way, what exactly is aphasia?".  She was denying coverage and did not even know what she was denying!  On another occasion, another insurance rep told her that the insurance company had declined a claim because the services had to be done by a Speech Therapist and not a Speech Pathologist (they are the same thing).   Again, lack of knowledge.

I myself just went through a similar nightmare.  Even though I had maternity insurance during my pregnancy, my insurance company repeatedly denied coverage for things such as ultrasounds and doctor visits and even the birth stating that the insurance only covered routine maternity.  I had a normal, non-eventful pregnancy, so I guess they thought I would be doing all of that if I were not pregnant.  Long story short, I fought each denial and one by one, I won.  It took about 6-8 months with many, many phone calls and emails, but I won.  I got back several thousands of dollars.   I don't know which was better, the money I got back or the satisfaction of beating the bully.

I say all of this to say, don't give up.  If you think your insurance is wrong in denying your claim, fight it.  Get your doctor, therapist and whoever else you need involved.  They will decline several times.  Just expect that, but know in the end it could be worth the fight.