How I Got My Health Insurance Company To Help Me

I suspect that my daughter and I are growing too costly and inconvenient for my health plan’s customer profile. They are genius (and stealthy) in their tactics to exhaust me financially, emotionally and physically. The company manuals must contain strategies for this, cleverly disguised as “working together.”

I have tried to be patient and cooperative. I pay the premiums for my top-tier PPO plan on time. I have accepted the fact I must cover a sizable deductible, copays, and coinsurance. It’s harder to swallow the exorbitant “out of pocket maximums” we are required to pay before a health plan will cover at 100%. Not many people hit that mark, and are likely bankrupt by then.

Looking at this logically, it was silly of me to believe the health plan when it said it wanted to help me or my family. After all, this is strictly business for the company, and businesses must make money. It’s nothing personal — unless we die.

I learned the hard way how to survive in this wild world. It entails reading the fine print, contending with confusing website portals, and enduring astonishingly long wait times while being serenaded by repetitive jazz when attempting to reach a live person.

Based on my decades-long journey, it appears that a health plan’s modus operandi is: When in doubt, deny. Unfortunately, at times I discover that a claim has been denied only after being contacted by a collections agency. Why? Because insurance approval or denial decisions can be delayed while providers are grilled for “more information” to justify their treatment plans, and bills deemed delinquent are routinely sent to collections.

Claims are typically rejected for one or more of these reasons:

• Preauthorization forms or superbills are not submitted properly.

• The facility or doctor is not in network.

• The treatment is not medically necessary. (That one is my all-time favorite.)

First, dealing with paperwork and shifting protocols during a crisis doesn’t help anyone’s well-being. This, coupled with the medical field’s reluctance to share digital files (citing privacy issues despite encryption solutions), means we are sent on a scavenger hunt for hard copies of our medical records, or must play digital hopscotch with external sites trying to transfer data into our insurance portals — which frequently malfunction. I believe these portals are programmed to crash multiple times a day. Once documents are submitted successfully, they aren’t always expedited to address…