Tuesday, June 12, 2012

Administration

In response to the article about my insurance battle in the Sacramento Bee, my boyfriend wrote a letter to the editor which was published today. We're all thinking about health care costs, and how they can be reduced--he argues that instead of denying treatment to those in need, the health care system should "cut the fat" from administrative costs.

Meanwhile, in Houston, I met the invaluable member of MD Anderson's Proton Therapy Center administration who crafted my first appeal to Anthem. Trained and experienced in nursing, Ms. H has spent the past several years specializing in "denials management," and enjoys a 60% success rate. When I read her appeal, I could not fathom how Anthem would reject it--and I quoted it in the appeal that eventually won. In addition to writing appeal letters, Ms. H spends a lot of time on the phone with insurance companies. Her medical credentials allow her to talk with the nurses and doctors protected from the public by customer service. These professional links are often crucial for the success of an appeal.

Patients facing insurance rejections are usually alone, and this is terribly costly on a personal level. Some, like UC Davis employees, have an advocate hired by their employer. Patients recommended for proton therapy at MD Anderson have Ms. H, but no other center within MD Anderson has such specialists. Most of us choosing to fight insurance denials have to draw from our own resources in a time when our attention should really be going toward other activities, like healing, packing up and moving to the treatment location, and getting in touch with friends and family for support. If our society can find a way to "trim the fat" that results in battles between insurance companies and the people they claim to serve, then the patients will do a better job "building our muscles" for the more important battles we fight against our diseases. Meanwhile, people like Ms. H, who have both medical training and a passion for getting patients the best treatment, can use their professional links to identify and access treatment options rather than wade through paperwork.

3 comments:

  1. Hi,

    I have a quick question about your blog, would you mind emailing me when you get a chance?

    Thanks!

    Cameron

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  2. The health insurance thing is OUT OF CONTROL! I have been researching this recently after having a close family friend encounter numerous rejections and outrageous costs just to try to survive.

    Woudl appreciate it if you checked out BTW... Its nice to find another network of blogs on this topic.
    http://cloudywithachanceofsnow.com

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  3. aloha Ms. Call,

    CONGRATULATIONS on your successful battle to have your proton therapy approved by your insurer!

    How can I contact Ms. H regarding advocacy for my good friend who has stage IV cancer (w/ a neck tumor similar to yours)? MD Anderson Center recommended he immediately begin proton treatment, but his case was denied by his insurer. We've begun a petition, signed by 200 supporters in two days & posted it to his insurer's Facebook page. We got response indicating they'd 'reach out to him' regarding this issue, & when they do, Ms. H's advocacy on his behalf would be HUGELY beneficial for providing prompt, medically effective & persuasive reply.

    MAHALO for all you do! You're a beacon of hope in an otherwise dark, bleak situation. Please feel free to contact me directly: dnraloha@gmail.com or thru my FB page (post right on the page, the more people who see this issue, the less insurers will be able to automatically deny better, more expensive treatment in favor of cheaper, less effective ones) at http://www.facebook.com/connie.rios.10 . Again, congratulations on all your fine work & your successful health outcome!

    mahalo, Connie Rios

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