7 Tips for Winning an Insurance Dispute, Making it Marginally Less Horrible, I Guess

If my life could be summed up in two words since moving to our condo, they would be: walking and talking.

Our car has been all but abandoned. I drive Luella to her doctor’s appointments on Tuesdays, stop for errands on the way home, and park it in the garage (I’m only scraping the passenger door against the cement beam by our spot about 10% of the time now, so GO ME), where it gathers dust until the next week.

Instead, we’re walking everywhere, favoring the flat streets, since Luella’s new wheelchair is HEAVY and I’m paranoid of accidentally letting go and it rolling down the hill. That fear remains, despite a sweet REI guy rigging up a wheelchair safety strap while I bombarded him with internet stories of getaway wheelchairs like it was the most normal thing he’d done all week.

Wheelchair

the new ride

While we walk, I talk. More accurately, I wait to talk, my phone perched atop the wheelchair, a god-awful recording repeating through the speaker:

“Your call is very important to us. One of our representatives will be with you shortly.”

As anyone knows who has made the grievous error of asking about Luella’s health care, (sorry everyone at the party who wasn’t able to slink out in time), we’ve spent 10 draining and infuriating months calling our insurance company to deal with a billing error.

Here’s the short version: the insurance company said they would pay for a maximum of 60 occupational/physical/feeding therapy visits in 2015. We counted that we used 47, but began receiving bills saying she’d exceeded her maximum by 12 visits. Uh, no.  And at $300+ per visit–which by the way, WTF–it was a huge issue.

Frowns-Edited

don’t even try

With dread, we called our insurance company nearly every week for almost a year, only to result in pointless discussions with customer service representatives who would read from the same booklet sitting in my lap.

But three weeks ago, I finally got the “smoking gun” when the insurance company sent their complete list of Luella’s visit dates. Lo and behold, THEIR OWN RECORDS showed she hadn’t reach the maximum visit count and we shouldn’t have been billed at all.

I RAGED. Within an hour, I’d sent a forceful letter to our insurance company’s Board of Directors and issued a formal complaint with the Washington State Office of the Insurance Commissioner. I heard back almost immediately from both, who said they would look into it. Last Wednesday, the answer came from our insurance company:

Errpr

That’s fancy insurance talk for “you’re right, we’re wrong.” We WON. And all it took was two letters, about 50 phone calls, and at least twice as many bottles of wine.

Since I consider winning this case my lifetime achievement (I’m not really joking), here are 7 tips  for people who are stuck in the health insurance vortex of evil:

  1. Keep your own damn records. You’d think that your records would match those of your provider and insurance company, but HAHA GUESS WHAT, you’d be wrong. Document everything.

    Cat on box

    finding enjoyment in 2.5 years of medical files

  2. Check your address. That, or never move.  Our address was mistyped in multiple places which meant we didn’t receive bills (that we shouldn’t have had in the first place) that were sent on to collections. It took three tries before it was corrected.  Just ask for the address on file every time you call, for all of eternity.

  3. Organize your information. We kept a file of Luella’s relevant insurance documents that we could refer to during calls. We used Google Docs and took photos of key papers so we could easily view them. And on that note…

  4. Take screenshots. Our insurance company tried to deny some visits that had been approved, until I mentioned that I had a screenshot. After putting me on hold for 10 minutes, the customer service representative returned to sheepishly admit, “We made a clerical error and gave you too many visits. But since it was our mistake, we’ll honor those extra visits.” Click. Click. CLICK.
  5. Demand a point person. A few times, we escalated beyond the base-level customer service representatives to a moderately helpful manager, who would tell us they are “definitely looking into it!”. And then…nothing.  Ever. I’m certain there is an island somewhere of kind, industrious customer service representatives that insurance companies have deemed bad for their bottom line. Demand one person, refuse to talk to anyone else.

    Smiles

    my point person

  6. Practice. Conversations about complex health insurance issues are really difficult over the phone. Rehearse ahead of time so that you can be concise on your call. It’s also a great opportunity to practice bleeping out the swear words.
  7. Make some noise. When all else fails, file formal complaints. Reach out to the Board, your insurance commissioner–ours has a very clear and responsive online process, by the way–or any other institution that will get their attention. State your demands clearly but without maliciousness, limiting your accusations of corruption to just once or twice (ahem).

The situation seems to be over now and I can move on, refocusing my efforts on sending complaints to other entities (oh hi, Public Works). I’ll go back to walking without a smarmy robot in my headphones endlessly thanking me for being on hold, as though I’d stayed on the line out of the goodness of my heart.

Painting

a more preferred mess

And when we fight our next battle–I’m no Pollyanna–we’ll be more experienced.  Although we switched insurance, I know we’ll be here again some day because this is the reality of caring for someone who needs a lot of care.

But for now? I’m counting it as a gold medal win.

Health/Life Update: Luella will be starting preschool in a few weeks! She’ll be attending developmental preschool through the Bellingham School District and we are EXCITED.  So far we’ve been impressed with the transition process and really like her teacher and the specialists.  Obviously it’ll be sad to have her away from me and blah blah all that, but I’m looking forward to her growing through this program.

We’re beginning to work with her on alternative communication through symbols.  We’ve made cards with symbols for songs, activities, feelings, etc.  and are trying to teach her what they mean (ex.: I show her a symbol of a bus and then sing “Wheels on the Bus). Eventually she may be able to communicate what she wants and how she feels by looking at the appropriate symbol. We’ll see!

Luella’s brief, 2- to 10-second seizures continue and while she has regular monitoring from her neurologist, they don’t seem to be causing any damage or pain at all. However, they look a little more gnarly in part because SHE is getting bigger.  If you bump into us and one of those happens, now you know what’s going on.  If I’m not freaking out, neither should you. 🙂

Couch Smiling

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