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Old 10-12-2008, 11:38 AM
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Harrison Harrison is offline
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Exclamation The Insurance Intelligencer

The Insurance Intelligencer : 10/10/08


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Insurance Company Words

Treatments are denied with words, and treatments are approved with words. I win all of these appeals because I understand insurance company words.

I have an M.A. in French Literature. This unlikely credential means that I am trained as a literary critic. To me, all words are propaganda. And it is my job to figure what they are trying to brainwash me to do.

Insurance words have two goals:

1. Make you feel very, very safe and cared for.
2. Keep the power in their hands.

Once we understand how insurance propaganda is deployed, we will not be stopped by it. As a matter of fact, we can use it to our advantage.

Names of insurance companies

Let's begin at the beginning. The name of the insurance company is designed to make you feel that they are on your side, and that they will keep you safe. What is the name of your insurance company?

Blue Cross/Blue Shield ... The insurer is my cross and my shield.
United Healthcare ... We are united. We have health. We CARE.
Neighborhood Health ... We are your friendly neighbor.

My favorite insurance name of all time? A man from Illinois called me. He had had brain surgery, and the insurer didn't want to pay for it. I asked, "What is the name of your insurance company?" He said -- I kid you not -- "Golden Rule Insurance."

Do unto others as you would have them do unto you. For crying out loud ... how would the Medical Director of your Golden Rule Insurance like it if they wouldn't pay for HIS brain surgery?

Don't be lulled into complacency by the name of your insurance company.

Names of departments at insurance companies

It used to be called "customer service." We are eager to serve you. But customer service has been amped up to "Customer Care." We CARE, we really do.

United Healthcare gets the Laurie Todd Hooplehead Award for the most devious department name of all time. A nice gentleman from Wisconsin called me one day. He had a rare form of testicular cancer, and UHC suddenly stopped paying for the only treatment that was keeping him going. He send me a heartrending account of the hundreds of fruitless phone calls that he had made to UHC, the call-back promises that were never kept, etc. Guess what department he was dealing with?

The Rapid Response Resolution Team

The job of the Rapid Response Resolution Team is to never, ever, under any circumstances call you back.

Names of people at insurance companies

Peope at insurance companies keep the power by not telling you their names. They will give you their first name, and a phone extension. Ever try to call that extension? They never work. Joke's on you.

What message does withholding of names send?

o I am not accountable.
o You will have to tell the whole story all over again next time.
o Any promises that I make are empty.
o I am really not here to help you, and I don't care.

My favorite name incident of all time? One of my helpees called the insurer, and asked for the name of the Medical Director. The "customer care" person answered, "Oh, we are not allowed to speak his name."

Is this like the thousand names of God? We dare not speak his name? I know that Medical Directors have divine rights over our life and death, but this is ridiculous!

Denial of care words

Now we understand that words are meant to persuade. We will not take them at face value. Insurance companies always use the same three phrases to deny care. What are they, and what do they make us feel?

Experimental/investigational

When I ask people what experimental means, they say, "not proven," "no randomized trials," "not FDA-approved." I have news for you. Insurance companies have paid for treatments that weren't FDA-approved, and they have denied treatments that are FDA-approved. Denial or approval is totally capricious.

There is no "experimental" list. Insurers have denied treatments as experimental, when they just paid for them last week. They have denied treatments as experimental, when they have paid for them hundreds of times. There is no substance, rationale, or logic behind these denials.

If your treatment is denied as experimental, just look up your insurer's definition of experimental, and disprove it in your appeal.

Not medically necessary

Does this mean "not needed for my health"? "Not needed for me to survive"? Has my insurance company done a lot of research to determine whether I need this treatment or not?

People, please. "Not medically necessary" is not a medical term. It is a legal term. This phrase was invented along with managed care back in the 1970s. It removes decision-making power from your doctor, and grants it to the insurer.

Go to your benefits booklet, and read their definition of medical necessity. Somewhere in the bewildering paragraphs of legalese, it will say: "Medically necessary as determined by the Medical Director of Acme Insurance Company." Because we said so.

Leap over this objection, there is no substance to it.

Out of network

The lifesaving treatment that I need is out of the network. I have no out-of-network benefit. That means that I have to sell my house to pay for it, right?

Wrong. If your health will suffer without this treatment, they can be persuaded to pay for it. Simply go to my new improved website, and use the appeal template from my "Winning Appeal Workshop," (www.theinsurancewarrior.com) and plagiarize to your heart's content.

The emperor has no clothes. Denials are bluffs. Just make your bluff better than their bluff, and you win.

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Catch my WEBINAR on Tuesday, October 14 -- 3:00 p.m.
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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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