More information from our good friend -- Laurie Todd!
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The Insurance Intelligencer
7/16/07
The Three Most Powerful Weapons
There are many components to an insurance appeal, and they should all be present to ensure success. The appeal must not be a “letter,” because a letter is not extensive enough, not substantial enough to be persuasive. No letters, they don’t carry enough weight. It must be an APPEAL DOCUMENT, with a title page, table of contents, cover letter, bullet list of facts, attachments, scary mistake-filled medical story, peer-reviewed studies, resume of your doctor-of-choice, cost comparison, and blockbuster conclusion with a call to action.
The facts are important, the tone of your writing (solid as a rock, totally dispassionate) is important, every detail of the appearance of your document is important.
After participating in a number of these successful appeals, I feel that there are three elements of the appeal that close the deal better than any other. They are the linch-pins of your appeal, they must be there, and they must be polished to perfection, and packed with power.
1. The Quotation Mark
People often call me on the phone and tell me about the outrageous things that their doctor or insurance company representative has said to them. Some examples ...
“Don’t even bother to appeal, because there is zero chance of it’s being accepted.”
“At your age, we don’t need to find out the cause of your rectal bleeding ... we will just give you a transfusion once a week.”
“There is no treatment for your disease.”
“Yes, we have paid for that surgery before. We paid for it by mistake, so we won’t be paying for yours.”
“We lost the fax, we lost the email, the letter got lost in the mail.”
“There are NO good outcomes with that surgery (when the only bad thing about the surgery is that it is out of network).”
“You don’t need any more surgery (when you really do).”
“You need surgery right away (when you ought best wait to see an expert).”
“Your husband is one of our highest-paid executives. If we funded the surgery for you, other employees would be jealous.”
These are all true examples. When anyone associated with your insurance company – doctor or bean-counter – says something outrageous, they have just handed you a nugget of solid gold.
There is nothing more powerful as a naked reporting of what goes on behind closed insurance doors.
Don’t tell me these things ... FIRE UP THE QUOTATION MARKS, AND PUT THEM IN YOUR APPEAL!
2. The Carbon Copy
Here’s the scenario: You write a beautiful appeal document – chock full of facts and intimidating medical mistakes, loaded with proof. Then, you send as directed by your insurance company, to “Mr. Joe Post Office Box.” You might as well throw your appeal in the trash. Why should Mr. Post Offfice Box help you out? There is nobody to check up on him, no accountability.
You must lavish time and effort on the list of important people to whom you will send a copy of your appeal. You will craft your own list, but I have some suggestions. Always copy the Medical Director of the insurance company. Sometimes it takes a little digging to find these people ... your appeal will have more impact just because they know that you were capable of finding a Medical Director. Then, copy a good list of executives at the insurance company. Copy your state’s Insurance Commissioner. Don’t really send him a copy, he doesn’t want to see your appeal. You just want the insurer to know that you know his name – and have probably contacted him. If this is a group policy through your employer, contact the highest HR executive at your company.
Did you find any lawsuits against your health insurer while you were Googling? Copy the attorney who won a lawsuit against them ... this is a name that they will recognize. Has your insurer been investigated by the Attorney General of your state? Copy him – another familiar name for your insurer. Copy the head of your state’s medical board.
Be realistic with your cc’s ... they know that Oprah isn’t going to be participating in your appeal.
The intention is to have your scary appeal land on many powerful desks at once, and to have many higher-ups picking up the phone to call your addressee. Now, Joe Post Office Box cannot ignore your appeal.
3. The Cost Comparison
This really is all about money. Your insurer has denied your treatment not because it is experimental, investigational, not medically necessary, or out of network. They have denied because they don’t want to pay for it.
The best way to nip this unspoken objection in the bud is to simply prove that the treatment you are proposing will COST LESS than the treatment your insurer is proposing. Since they are probably proposing no treatment at all, and you will get worse without any treatment, this shouldn’t be too hard to prove.
Spelling out all of the terrible expensive things that will happen to you if you DON’T get the treatment serves three purposes:
It puts the kibosh on their true motivating objection: We are denying your treatment to control our costs.
2. It serves notice to your insurer, in a very subtle way, that you understand what is behind this denial – money.
You have already told about your past malpractice-worthy medical story. With
the cost-comparison, you get to tell your possible future malpractice-worthy story – if they don’t pay.
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Reviews
Fight Your Health Insurer and Win
Laurie Todd
Healthwise Publications
PO Box 2045, Woodinville, WA 98072
9780979143502, $14.95
www.theinsurancewarrior.com
According to Reader's Digest in April of 2006, seven in ten adults who were driven into debt by medical expenses had insurance at the time. Author Laurie Todd had health insurance when she was diagnosed with a rare form of cancer, but in order to obtain the expensive treatment necessary to save her life, she had to battle her insurance company tooth and nail. Fight Your Health Insurer and Win: Secrets of the Insurance Warrior is a distillation of what she learned—a lifesaving, no-nonsense guide written especially for sufferers of cancer and other deadly medical afflictions. Chapters cover how to qualify one's own doctors (and make sure one's provider is not only generally competent, but an expert in one's specific affliction), manage one's own care, find the best care possible for one's disease, and force one's health insurer to bear the full cost (a common practice among insurers is to pay an "out-of-network benefit" that covers only 60%-80% of the cost—which is just not enough when some surgeries can cost, $200,000 or more). Also discussed are how to research the life's work of one's physician on Google and ask him questions about his practice (it's important to listen to the tone of the answers as well as the answers themselves); why terms like "experimental/investigational procedures" and "medically necessary" are little more than manipulative word-dancing meant to frighten away people from demanding insurance payment; how to respectfully and persuasively present one's case to insurance industry bureaucrats and medical professionals who have a vested financial interest in your imminent death (if you die quickly, they don't have to pay for your treatment); and much more. Sample letters, step-by-step procedures, guidelines for telephone conversations, and above all the admonition to never give up infuse Fight Your Health Insurer and Win with literally life-giving energy and wisdom. Highly recommended, and an absolute "must-have" for anyone who has paid their health insurance dues.
Susan Bethany
Reviewer
http://www.midwestbookreview.com/rbw/jul_07.htm#bethany
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Where to Buy the Book
My book is available from my website and several independent bookstores in the Seattle area (University Bookstores, Village Books in Bellingham). No chain stores, none of that. You may order the book by ...
Go to
www.theinsurancewarrior.com and use the Buy Now button.
Call me at 425 497-1858, and I will take your order by phone. Send me a check for $19.95 if you are outside of the state of Washington, and $21.32 if you are in Washington:
Healthwise Publications
P.O. Box 2045
Woodinville, WA 98072
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The Insurance Warrior Speaks – in Public
A speaking career seems to be developing naturally, as the book spreads across the country.
If you know a group or organization who needs to hear this empowering insurance message, just give me a call.
My best, and good Insurance Warrior-ing to all.
Laurie Todd
laurie (at) theinsurancewarrior.com
425 497-1858