Don't let the bastards grind you down
Witchy tips for getting yours from health insurance companies
The other day we discussed some health insurance nightmares and people shared others on Twitter:
But aren’t there always those urban legends about the woman who called the credit card company and asked them to take a grand off her bill and they just did it? So, what have you learned about fighting insurance nonsense? Here’s what I’ve gleaned from other witches thus far:
I use Canada, which is my hot tip for ANYONE who's looking for help getting name brands. I was worried it was illegal but I found it recommended on several state health exchange official websites, which, amazing work, America. Also, one time I noticed a countdown on the box, like, "You have x number of pills left in RX" and I called Canada in a panic and was like, "Do I get cut off at that point for the year?' and the befuddled customer service person said, "No, you just send in a new prescription." And I responded, "Listen, I am calling from America, where they WOULD cut you off for the rest of the year."
My daughter had stitches by a plastic surgeon who was not covered through insurance, but was the on-call for the urgent care center we went to when it happened. It was on a Sunday. The best help I got was talking to the person who worked the desk at the plastic surgeon's office about how to get it covered - she knew exactly the language to use to file an appeal with my provider.
I'm a doctor [in New York], and in in some cases I have been able to get a voucher for free medications from the pharmaceutical company for certain patients who need the medication and are uninsured or who can’t afford it. You can call the company directly and inquire about drug-assistance programs and see whether they offer it for the medication in question. It’s a bit of paperwork but I imagine most doctors would not mind doing it if it meant not having to deal with prior authorizations and headache for their patients. In one instance they needed some financial info from the patient but there was another instance in which they didn’t ask for anything and just mailed the Rx directly to the patient’s home every month. I just needed to call the company periodically to renew the Rx phone, something like every three months.
For large bills, I always ALWAYS call the doctor/hospital and ask if there is a discount for payment in full. Usually you can get about 20% off. Sometimes they will even do a retroactive adjustment if you ask. [ ⬅️The urban legend is real! ]
Fighting with insurance companies is something I hate but I will go after every dime on principle. They are sloppy and evil and they deny my shit on average 2-3 times a year, because they think they can get away with not paying. So far, I’ve gotten every denial overturned. The biggest ones in the past few years:
1. I had an incomplete miscarriage a few years ago and then had to get an unmedicated D&E in my OB’s office (that is a nightmare I don’t recommend). My insurance denied it as an elective surgical abortion when the policy only covered abortions performed with medication, and I got a bill for $4K. Went apeshit on both the insurance company and my OB’s office who had coded the procedure wrong.
2. Aetna denied coverage for my son’s speech therapy because he didn’t have a diagnosis. Except he did, and I had provided it in writing.
3. They denied coverage for my mammogram last year because I’m 38. So I had to fight with them about ACOG standards for women with a family history (I should be covered for mammograms starting at 34). The eventually relented, but I’m prepared to have the same fight all over again for the mammogram I had last week.I come to the fight very prepared. Before I call, I make sure I know exactly what the policy covers and what documentation is required. I will have researched the billing codes, and called my doctor’s office if I need more clarification on what they’ve coded. I will have done research about best practices and standard of care, and I will be a huge pain in the ass if it’s a gray area. I’m also not shy about calling my doctor(s) and asking them to advocate for coverage, but I make sure I’m prepared before that conversation. And finally, if many hours and phone calls don’t make them reconsider, I type it all out in a letter full of legalese and I make sure they know I’m a lawyer. It’s a fuckton of work but those assholes are going to give me what I’m legally entitled to.
If you have used other forms of sorcery to get what you deserve from insurance companies please let us know via email, comments or Twitter.
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One witchy thing
I'm adding comments that I'm getting via email that might be helpful!
"Hello,
Another tip for battling insurance companies - the three way call between you, your insurance co, and your provider. Begin with your provider/their billing department, say you need to get your insurance co on the line to sort this out, they do the dialing; once everyone is on the line, you give authorization for both parties to discuss the issue at hand; the provider and insurance co sort things out and you save yourself 8,764 hours of phone calls between the two.
I've used this strategy multiple times - once when my IUD wasn't covered because of a billing error and again for a preventative care visit that was incorrectly billed.
Cheers,
Jennie Nye"