Never, Never, Never Give Up

Call me perverse and paranoid, but I have this theory, and here it is: Once you get a single letter denying your claim for health services rendered, you can expect to begin to get a steady flow of such denials——IF you do not make prompt and consistent contact with the insurance company to argue your case.

It’s like the insurance company is looking for the slightest crack in your armor and when they find that area of possible vulnerability, they will do their mightiest to wedge a sword in and twist it hard. Then, when you’re weakened and bleeding and your last breaths are coming in fits and spurts——meaning you have an absolutely undeniable claim on their benefits!—-they put you on hold so that they can dash off another letter apprising you of your few and diminishing hopes for satisfaction.

Here’s my advice, and trust me, it’s good: When you get that first letter turning down your claim, get yourself on the phone with the insurance company and explain yourself. If you don’t LOVE the attitude, intelligence, and general demeanor of the rep you’re speaking to, fake a disconnection and call again. I guarantee you that, while the next person to take your call can see the name of the person you just spoke with and the extent of the conversation you’ve had so far, you will NOT be reconnected to the original rep.

Now, if you think you are clicking with the rep who takes your call, get her name and EXTENSION NUMBER immediately. That way, when you call back and someone less competent/caring picks up the line, you can either ask for Sarah (who will never be available, of course, and besides, Sam has everything in front of him and can take it from here, ha-ha) or insist on being put into her voice mail.

Here’s the reason: It’s actually possible that you may develop a fantastic enough rapport with a certain rep that she will end up advocating for you in ways you cannot anticipate or expect. You do NOT want to lose that relationship, once it’s begun!! Having someone on the inside can mean more to you than all the appeals processes in the world, and the appeals process is exactly where I was headed, starting today.

I have had seven or eight claims of various sizes denied by my health insurance company since October. As you might remember, I was an inpatient for five days over Thanksgiving (mmmm…..clear chicken broth for a holiday feast!) and for some reason I still don’t understand, my insurance decided that only ONE day was medically necessary. My primary doctor had to schedule a peer-to-peer appeal with a doctor who works for the insurance company, and finally my entire hospital stay was deemed necessary.

That started the stream of denials that has filled my mailbox and mind ever since. As of last night, I had the outstanding denials whittled down to $2530, but people. Even when I’m sick——even when I’m bedridden!—-I refuse to take this stuff lying down.

I left a message in Sarah’s voicemail after hours yesterday, assuring her that I thought I had found the glitch that had caused my claims to be mistakenly denied. She called me back first thing this morning, and let me know that I had made a serious error in how I attempted to use the company’s website to find doctors who are in my network. I was shocked to hear this, as I had followed the website’s cues to a tee, and still came to a conclusion that caused me to seek treatment from an out of network doctor.

I explained to her, from the point of view of the spouse of a professional website developer, that the site was not the least bit intuitive and easily leads patients to wrong conclusions about their coverage. She listened patiently, but basically said there was nothing for me to do but to begin a long written appeals process, which would probably gain me nothing.

I did not behave antagonistically toward her, since she was perfectly nice, helpful, and knowledgeable. And before we hung up, she said, “Now you’ve got my extension number, right? Call me back anywhere along the line in this process.”

I got off the phone, and Doug and I discussed how we would have to take this up with our doctors, as they clearly led us to believe that they were in the network of our healthcare providers. Just when I was about to initiate the first call in this process, the phone rang. It was my new best friend, Sarah.

She had singlehandedly taken my case before her superior and gotten them to agree to pay the charges of the out-of-network doctor in full, based on the persuasive argument I was able to lay out before her. Because I insisted on being reconnected to her, rather than passed along through an endless chain of reps, she somehow formed a connection with me and with my case that moved her to action on my behalf.

So as of this morning, $1338 of the disputed amount has been resolved in my favor! The remaining $1192 worth of denied benefits are also being disputed by me—-and maybe by Sarah, too, since she seems to have taken my part in this miserable situation.

My main point here is that when you find yourself in a seemingly untenable situation like denied insurance claims, don’t take the company’s first response as their final answer. I’ve got too much fightin’ Irish in me to give up that easily! And even though it IS a fight, don’t forget that you just might find a comrade on the other side, who will see your case through to a satisfactory conclusion if you stay connected to her.

And whatever you do, don’t lose her extension number. Those four little digits could save you the very big bucks.

Posted by Katy on 01/16/09 at 11:19 AM

Fallible Comments...

I've had a curious experience with this...I tend to lose my patience with clerks, but if I get a female clerk I will often turn it over to my husband (who sounds like Jimmy Stewart on the phone). They will work with him. Vestiges of sexism. :)
Posted by Terri on 01/16/09 at 06:33 PM
The doctors led you to believe they were in the network? If they do that, how can we be expected not to make mistakes? And did they expect they'd keep you as a patient when you found out they weren't?
Posted by marcia on 01/17/09 at 08:07 PM
Thanks for the great article, do you have any additional resources you can point us to to learn more?
Posted by San Diego Personal Injury Lawyers on 02/04/09 at 05:32 AM
Really a educative and informative post, the post is good in all regards,I am glad to read this post
Posted by elisha-Alaska Personal Injury Lawyer on 03/07/09 at 06:21 AM
In my experience, dealing with the insurance companies is always a battle. You can't just go by the first thing they tell you if it's not to your satisfaction. Keep pushing and you are likely to get through to them one way or another. I'm glad you found that Sarah and it's good to know there are still people like her who actually care about helping and fairness.
Posted by San Diego Movers on 03/11/09 at 04:16 PM
Beautiful blog with great informational content and Thanks for this great sharing.
Posted by Insurance reviews on 09/02/10 at 11:29 AM

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Personal blog of christian writer & fallible mom Katy McKenna Raymond in Kansas City, Missouri Katy is represented by Greg Johnson at WordServe Literary Read more Katy at LateBoomer.net Follow Katy on Twitter Follow Katy on Facebook 123 Recent Posts Try Becoming Brenda Starr Off Beat Scattered That’s It So I’ve Finally Signed With An Agent. Now What? The Spoon Sciatica Sweetheart A Woman’s Train of Thought Has No Caboose However much we own, we are all still living on borrowed time After all, when restaurants shrink portions, they don’t shrink prices. As with everything in life, balance is key. Slow down, you move too fast… Yeah, I know. I have issues. Search Advanced Search Syndicate Login E me at katy @ ngenius.com	Never, Never, Never Give Up Call me perverse and paranoid, but I have this theory, and here it is: Once you get a single letter denying your claim for health services rendered, you can expect to begin to get a steady flow of such denials——IF you do not make prompt and consistent contact with the insurance company to argue your case. It’s like the insurance company is looking for the slightest crack in your armor and when they find that area of possible vulnerability, they will do their mightiest to wedge a sword in and twist it hard. Then, when you’re weakened and bleeding and your last breaths are coming in fits and spurts——meaning you have an absolutely undeniable claim on their benefits!—-they put you on hold so that they can dash off another letter apprising you of your few and diminishing hopes for satisfaction. Here’s my advice, and trust me, it’s good: When you get that first letter turning down your claim, get yourself on the phone with the insurance company and explain yourself. If you don’t LOVE the attitude, intelligence, and general demeanor of the rep you’re speaking to, fake a disconnection and call again. I guarantee you that, while the next person to take your call can see the name of the person you just spoke with and the extent of the conversation you’ve had so far, you will NOT be reconnected to the original rep. Now, if you think you are clicking with the rep who takes your call, get her name and EXTENSION NUMBER immediately. That way, when you call back and someone less competent/caring picks up the line, you can either ask for Sarah (who will never be available, of course, and besides, Sam has everything in front of him and can take it from here, ha-ha) or insist on being put into her voice mail. Here’s the reason: It’s actually possible that you may develop a fantastic enough rapport with a certain rep that she will end up advocating for you in ways you cannot anticipate or expect. You do NOT want to lose that relationship, once it’s begun!! Having someone on the inside can mean more to you than all the appeals processes in the world, and the appeals process is exactly where I was headed, starting today. I have had seven or eight claims of various sizes denied by my health insurance company since October. As you might remember, I was an inpatient for five days over Thanksgiving (mmmm…..clear chicken broth for a holiday feast!) and for some reason I still don’t understand, my insurance decided that only ONE day was medically necessary. My primary doctor had to schedule a peer-to-peer appeal with a doctor who works for the insurance company, and finally my entire hospital stay was deemed necessary. That started the stream of denials that has filled my mailbox and mind ever since. As of last night, I had the outstanding denials whittled down to $2530, but people. Even when I’m sick——even when I’m bedridden!—-I refuse to take this stuff lying down. I left a message in Sarah’s voicemail after hours yesterday, assuring her that I thought I had found the glitch that had caused my claims to be mistakenly denied. She called me back first thing this morning, and let me know that I had made a serious error in how I attempted to use the company’s website to find doctors who are in my network. I was shocked to hear this, as I had followed the website’s cues to a tee, and still came to a conclusion that caused me to seek treatment from an out of network doctor. I explained to her, from the point of view of the spouse of a professional website developer, that the site was not the least bit intuitive and easily leads patients to wrong conclusions about their coverage. She listened patiently, but basically said there was nothing for me to do but to begin a long written appeals process, which would probably gain me nothing. I did not behave antagonistically toward her, since she was perfectly nice, helpful, and knowledgeable. And before we hung up, she said, “Now you’ve got my extension number, right? Call me back anywhere along the line in this process.” I got off the phone, and Doug and I discussed how we would have to take this up with our doctors, as they clearly led us to believe that they were in the network of our healthcare providers. Just when I was about to initiate the first call in this process, the phone rang. It was my new best friend, Sarah. She had singlehandedly taken my case before her superior and gotten them to agree to pay the charges of the out-of-network doctor in full, based on the persuasive argument I was able to lay out before her. Because I insisted on being reconnected to her, rather than passed along through an endless chain of reps, she somehow formed a connection with me and with my case that moved her to action on my behalf. So as of this morning, $1338 of the disputed amount has been resolved in my favor! The remaining $1192 worth of denied benefits are also being disputed by me—-and maybe by Sarah, too, since she seems to have taken my part in this miserable situation. My main point here is that when you find yourself in a seemingly untenable situation like denied insurance claims, don’t take the company’s first response as their final answer. I’ve got too much fightin’ Irish in me to give up that easily! And even though it IS a fight, don’t forget that you just might find a comrade on the other side, who will see your case through to a satisfactory conclusion if you stay connected to her. And whatever you do, don’t lose her extension number. Those four little digits could save you the very big bucks. Posted by Katy on 01/16/09 at 11:19 AM Fallible Comments... I've had a curious experience with this...I tend to lose my patience with clerks, but if I get a female clerk I will often turn it over to my husband (who sounds like Jimmy Stewart on the phone). They will work with him. Vestiges of sexism. :) Posted by Terri on 01/16/09 at 06:33 PM The doctors led you to believe they were in the network? If they do that, how can we be expected not to make mistakes? And did they expect they'd keep you as a patient when you found out they weren't? Posted by marcia on 01/17/09 at 08:07 PM Thanks for the great article, do you have any additional resources you can point us to to learn more? Posted by San Diego Personal Injury Lawyers on 02/04/09 at 05:32 AM Really a educative and informative post, the post is good in all regards,I am glad to read this post Posted by elisha-Alaska Personal Injury Lawyer on 03/07/09 at 06:21 AM In my experience, dealing with the insurance companies is always a battle. You can't just go by the first thing they tell you if it's not to your satisfaction. Keep pushing and you are likely to get through to them one way or another. I'm glad you found that Sarah and it's good to know there are still people like her who actually care about helping and fairness. Posted by San Diego Movers on 03/11/09 at 04:16 PM Beautiful blog with great informational content and Thanks for this great sharing. Posted by Insurance reviews on 09/02/10 at 11:29 AM Page 1 of 1 pages Commenting is not available in this weblog entry. Next entry: Throw Mama From The Brain? Previous entry: Personal Banking DOES Pay Off!!! << Back to main


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Personal blog of christianwriter & fallible momKaty McKenna Raymondin Kansas City, Missouri

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Never, Never, Never Give Up

Personal blog of christian
writer & fallible mom
Katy McKenna Raymond
in Kansas City, Missouri