Fighting the Big Man

Prior to my cancer diagnosis, I was relatively healthy and saw a doctor once (maybe twice) a year.  That usually meant about $30 out of pocket for co-pays and a maximum of 2 “Explanation of Benefits” to read/review.  Usually I just tossed the EOB’s because everything was routine and covered in full.  I’ve learned a lot over the past year or so, but one of the most useful lessons I’ve learned is how to deal with my insurance company. 

I hate the fact that I even have to pick up the phone in the first place, but I think I have mastered the art.  Fortunately for me, each person I’ve talked to on the phone has been pleasant and was able to help me resolve my issues.  Here’s some tips I found helpful:

  • Read your benefits book and get to know what type of insurance plan you have.  I’m definitely guilty of not doing this. 
  • If the insurance company has an automated system (as mine does), just keep pressing 0 (zero) until you get a live person on the line.  I have Blue Cross Blue Shield and I don’t like listening to whole list of “press 1 for this, 2 for that.”  Each time I press zero, I’ve been lucky and have been connected to a live person almost immediately. 
  • When you do have to call the insurance company or doctor’s office, be nice to the person on the other end of the phone.  I tend to get excited and worked up very easily (hey, I am half Italian and originally from New Jersey), but I have learned that being polite really helps the situation.  After all, its not that person’s fault, they just happened to have answered your call.
  • Have a pen and paper ready.  Take notes and get the name of the person you speak with along with the date and time of the call.  Although my insurance company logs all the calls, I still find this information useful.
  • Don’t be afraid to follow-up.  If someone is supposed to call me back or fix a benefit online and they don’t, I usually wait 3 – 5 business days before I follow up (and again, I use my polite voice). 
  • When you receive that Explanation of Benefits (EOB) that says “service/procedure not covered” – don’t freak out.  I’ll admit that for about the first 10 times I received EOB’s with those words on them, I did freak out.  But as I soon learned, 99% of the time, the service/procedure was covered, but was just coded incorrectly by the doctor’s office. 
  • If the service/benefit truly is not covered (as with me not meeting the medical criteria for IVF), roll up your sleeves and don’t be afraid to submit an appeal.  I’m so glad that Bri and I took the time to thoroughly research and write our appeal.  It paid off big time.  My doctor’s office recently reposted an old NY Times article on their Facebook page about insurance appeals.  Check it out here.  And yes, I follow one of my doctor’s offices on Facebook, I’m a loser. 
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