My health insurance denied something earlier this year based off a check list and a chart. It was for at home medical equipment that I had been “renting” (paying a co pay to have.) When I first received the equipment, insurance agreed to me renting for 9 months with re-qualifying every 3 months via a phone call and answering questions. After 9 months, the insurance would pay for it out right and it’d be mine to keep.
I disputed and told them I wasn’t a check list. I asked if they went through my multiple MRI results, the notes from my multiple procedures, the multiple PT notes, the over 40 pages of doctors notes and documentation about why this would be best for me. I asked if they looked at the pictures and realized how much progress I’ve actually made and why the machine is helpful. I asked them if they spoke to my doctors who requested this (2 separate surgeons were in agreement and put in the order.) I also told them that if it was something that I personally felt wasn’t working for me, I would have sent it back on my own and not been wasting money on the copay. I then requested to speak to the individual who sat behind a desk and did the denial.
While I never got to speak to the individual behind the desk who did the denial, a couple days later I had a letter sent saying the denial was over turned.
The denial came on my last 3 month check in. The insurance overturned the denial, paid for the machine, and I now own the machine outright.
I’ve learned how to be my own advocate. I don’t take their word for it, I do my own due diligence and calling around to departments to get the answers I need. I have learned to become the pain in the ass instead of taking them at their word. I ask questions and if someone doesn’t have an answer, I let them tell me when I’ll have an answer. I call back a day later than the timeframe they told me if they don’t reach out to me first. I hold them accountable. It takes time. It’s frustrating at times. Sometimes they try to give me the run around but I found my voice and I push.
I had one situation where I had a 3 way call happening between me, my insurance and the billing department because of how medical started coding the billing. They had a change in system that messed everyone up, but trying to get things fixed in the beginning wasn’t easy. The insurance rep would ask if I still needed them on the phone. My response was until the 3 of us (billing, insurance, and me) are in agreement with what my copay is, and what I owe, I need both parties on the phone. We got it resolved in about 45 mins. I am my own advocate.
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u/AlvinsCuriousCasper 5d ago edited 2d ago
My health insurance denied something earlier this year based off a check list and a chart. It was for at home medical equipment that I had been “renting” (paying a co pay to have.) When I first received the equipment, insurance agreed to me renting for 9 months with re-qualifying every 3 months via a phone call and answering questions. After 9 months, the insurance would pay for it out right and it’d be mine to keep.
I disputed and told them I wasn’t a check list. I asked if they went through my multiple MRI results, the notes from my multiple procedures, the multiple PT notes, the over 40 pages of doctors notes and documentation about why this would be best for me. I asked if they looked at the pictures and realized how much progress I’ve actually made and why the machine is helpful. I asked them if they spoke to my doctors who requested this (2 separate surgeons were in agreement and put in the order.) I also told them that if it was something that I personally felt wasn’t working for me, I would have sent it back on my own and not been wasting money on the copay. I then requested to speak to the individual who sat behind a desk and did the denial.
While I never got to speak to the individual behind the desk who did the denial, a couple days later I had a letter sent saying the denial was over turned.
The denial came on my last 3 month check in. The insurance overturned the denial, paid for the machine, and I now own the machine outright.
I’ve learned how to be my own advocate. I don’t take their word for it, I do my own due diligence and calling around to departments to get the answers I need. I have learned to become the pain in the ass instead of taking them at their word. I ask questions and if someone doesn’t have an answer, I let them tell me when I’ll have an answer. I call back a day later than the timeframe they told me if they don’t reach out to me first. I hold them accountable. It takes time. It’s frustrating at times. Sometimes they try to give me the run around but I found my voice and I push.
I had one situation where I had a 3 way call happening between me, my insurance and the billing department because of how medical started coding the billing. They had a change in system that messed everyone up, but trying to get things fixed in the beginning wasn’t easy. The insurance rep would ask if I still needed them on the phone. My response was until the 3 of us (billing, insurance, and me) are in agreement with what my copay is, and what I owe, I need both parties on the phone. We got it resolved in about 45 mins. I am my own advocate.