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Old 10-31-2011, 08:55 PM
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Harrison Harrison is offline
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The Insurance Intelligencer
10/30/11

Sharlene hits a home run

People often ask, "Which insurance company is the worst?" The diplomatic answer? They are all equally bad. The true answer? Anthem Blue Cross Blue Shield of Virginia.

I lost to Anthem BC/BS of Virginia two years ago. Just when it looked like I was going to lose to them again, my helpee did something that I would never advise anyone to do -- and saved the day.

A bitter loss

In 2009, I fought Anthem BC/BS of Virginia for the first time. I soon learned that I was up against a mighty foe. When I faxed the appeal to the executives at Anthem, none of the half-dozen fax numbers worked. That has never happened before or since.

I did everything that I could think of, and I never got the slightest reaction out of Anthem.

My helpee in this case was Buck -- a true Southern gentleman. He had late-stage colon cancer, and he needed expert surgery. It was a bitter loss.

I swore that I would never lose to any Anthem BC/BS company ever again. Over the next two years, I fought Anthem BC/BS of California and won -- twice. I fought Anthem BC/BS of Connecticut twice, and won both times. All the while looking over my shoulder, watching for my nemesis.

Last week Anthem BC/BS of Virgiinia came a-knockin'.

I had one day to write the appeal, and one day to win it. With a case like this, I wished for a helpee with personality of a pit bull. I got Sharlene. She was as sweet as could be. However, she was no pit bull. Or so I thought ...

Sharlene hits a home run

Suddenly, things started moving. The door was cracking open, Anthem was finally answering calls ... they were getting ready to do business.

I called Sharlene, "What did you do?"

Sharlene said, "I was sitting at my kitchen table, worrying about the appeal. Among the stacks of papers, I noticed a letter from my Congressman. The letter said, 'If there is anything that I can do for you, please call.' So I called my congressman."

I have never advised calling your congressman, when treatment is denied. Usually, politicians couldn't care less about our medical treatments, and insurance companies couldn't care less what politicians have to say. However -- against all odds -- Sharlene made it work.

It so happened that the congressman was running for re-election -- which made him a little more susceptible to a media-worthy story like this. Plus, he didn't have to do any research. Sharlene simply faxed the appeal, and gave him the names and phone numbers to call the executives and Anthem BC/BS.

Sharlene said exactly the right words, in exactly the right way. The congresssman jumped all over this case, and spent the rest of the day on the phone with the insurance company.

At 5:02 p.m. on Friday, Anthem BC/BS of Virginia finally -- and very reluctantly -- approved the surgery, and signed the single-case contract with Dr. Sugarbaker's office. Sharlene had her surgery on Tuesday. She is doing very well.

I love it when my helpees rise magnificently to the occasion. And I love it when a case is won in a new, unexpected way that I could never have imagined.

This one's for you, Buck.

Happy and peaceful Insurance Warrior-ing,

Laurie Todd
health insurance help
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
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