Laurie the IW
10-13-2009, 09:56 AM
Well, I'm here now. Every person with any condition that requires them to actually USE their health insurance is in the same position that you are. The only difference is that most treatments that I fight for are in the $100,000 to $500,000 range.
It is their job not to pay. The sooner we realize this, the more empowered we are to make them pay.
Thank you for sharing your story, let's help the new moms not to go down the same difficult path.
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When it comes to health insurance, we are in a position that calls for a new way of thinking. People write letters to educate their insurers about the denied treatment.
People. Learning moment here. The insurer already knows all about your treatment. They have paid for it hundreds of times before.
The purpose of a winning appeal is not education; it is INTIMIDATION.
This is not about making sure that you or your family receive the safest and most effective treatment for your condition or disease. They deny because they don't want to pay.
How do I know this? Let me count the ways. I have fought Regence in Washington for the same out-of-network cancer surgery six times. For six different patients. Every time I prepare the same masterpiece of persuasive expository prose, and send it to the same top-level decision-makers at Regence. I prove the points a dozen different ways, I win the case, they pay it all.
Guess what happens the next time a patient requests this same out-of-network treatment? They deny again, calling it "Experimental."
How "experimental" could it be, if they have paid for it six times in the past two years?
While you are earnestly preparing your appeal, ready to prove that this treatment will help you ... they just paid for your treatment last week, and they have no intention of paying for it again.
Ladies, I am asking for a paradigm shift here. Not only is the insurer not your friend. They have a thousand extremely clever ways to keep you swirling around in their "due process" until it's too late. They will do and say anything to not pay.
It is their job not to pay. And your job to make them pay.
Laurie Todd
The Insurance Warrior
www.theinsurancewarrior.com (http://www.theinsurancewarrior.com/)
It is their job not to pay. The sooner we realize this, the more empowered we are to make them pay.
Thank you for sharing your story, let's help the new moms not to go down the same difficult path.
********
When it comes to health insurance, we are in a position that calls for a new way of thinking. People write letters to educate their insurers about the denied treatment.
People. Learning moment here. The insurer already knows all about your treatment. They have paid for it hundreds of times before.
The purpose of a winning appeal is not education; it is INTIMIDATION.
This is not about making sure that you or your family receive the safest and most effective treatment for your condition or disease. They deny because they don't want to pay.
How do I know this? Let me count the ways. I have fought Regence in Washington for the same out-of-network cancer surgery six times. For six different patients. Every time I prepare the same masterpiece of persuasive expository prose, and send it to the same top-level decision-makers at Regence. I prove the points a dozen different ways, I win the case, they pay it all.
Guess what happens the next time a patient requests this same out-of-network treatment? They deny again, calling it "Experimental."
How "experimental" could it be, if they have paid for it six times in the past two years?
While you are earnestly preparing your appeal, ready to prove that this treatment will help you ... they just paid for your treatment last week, and they have no intention of paying for it again.
Ladies, I am asking for a paradigm shift here. Not only is the insurer not your friend. They have a thousand extremely clever ways to keep you swirling around in their "due process" until it's too late. They will do and say anything to not pay.
It is their job not to pay. And your job to make them pay.
Laurie Todd
The Insurance Warrior
www.theinsurancewarrior.com (http://www.theinsurancewarrior.com/)