Turning No Into Yes: How to Fight Your Health Insurance Company and Win
grace wood has a superpower: she can make $147,000 in medical bills disappear.
wood does not have a magic wand. its power comes from hard-earned experience navigating costly care for atrial fibrillation, a type of abnormal heart rhythm. Although his tenacity helps, the real driver of Wood’s success is a keen survival instinct: he refuses to let us. uu. the health system breaks it, financially or otherwise.
“why should I ruin my life?” said the wood.
Fighting insurance denials and negotiating exorbitant medical bills takes more than willpower, but that, too, is essential. But with rising out-of-pocket costs and rising premiums, it’s important not only to understand your rights, but also how to insist on them to get the care you need and the coverage you’ve paid for.
wood, a 61-year-old speech coach from Northern California, has learned what insurance and billing experts know: As infuriatingly bureaucratic and rigid health care can be, you can find insiders. with the knowledge, authority and motivation to use their discretion to help you. the trick is how.
ask for a break (yes, it can be that simple)
wood hospital forgave a $12,000 emergency room bill (part of the $147,000 it owed for a heart procedure) through “charity care,” which nonprofit hospitals are required to provide and hospitals with For-profits provide, sometimes even more than non-profits.
wood asked his other providers to cancel their bills as well, letting them know the hospital had already done so. several agreed, and just like that, $20,000 in medical bills were gone.
The rest of Wood’s bills required more effort and consultation with a professional, Mary Covington, President of Denial Management, who charges hourly rates to help consumers fight insurance denials. Together, they finally got the insurance company to overturn their denial and reimburse the hospital for Wood’s charity care, which she, too, thought was fair.
one of covington’s tips: “always write a letter”.
insurers may offer you the opportunity to appeal by phone, but covington says no.
“You have to put the evidence in the file,” he says, in writing.
gail trauco, a nurse who founded medical bill 911 to help consumers reduce their medical bills, takes paper trailing to the next level. She suggests sending copies of anything she writes to her health insurer to her state insurance commission as well and to consumer protection authorities like the attorney general’s office.
The authorities likely won’t get involved until you exhaust the insurance appeals process, but it won’t hurt your insurer to know that their regulators have one eye on your case.
don’t just write it, write it well
It is not enough to put your arguments in writing. your arguments must be convincing.
Show the insurance company how much more it will cost you not to cover your care, for example, if you have to pay for a more expensive procedure or treatments that are covered but don’t work. speak your language. insurers care about money.
If you’re faced with a huge hospital bill, you may need to help the hospital see your situation in the right light.
braden pan, founder of resolve, a company that reviews consumers’ medical bills for a flat fee plus a percentage of the savings it negotiates, had a client with an $80,000 bill for a medical device that insurance wouldn’t cover .
The patient was earning too much to qualify for the hospital’s financial assistance program, but not enough to make $80,000 reasonable. Pan and his team argued in detail that $80,000 was out of his reach. By repositioning the patient’s income relative to the bill, Pan says they cut the bill in half.
“You have to fight bureaucracy,” said Pan. “You basically have to say, ‘This is the answer I want and I’m going to go get it.'”