Panic — it’s the feeling in the pit of your stomach upon learning that your insurance company has denied coverage for your medication or treatment. Laurie Todd, a survivor of late-stage appendix cancer, has gained a reputation as “The Insurance Warrior” because she has fiercely fought insurance companies . . . and won.
The Carcinoid Cancer Foundation is delighted to partner with Laurie Todd to bring information to the carcinoid cancer and neuroendocrine tumor community to help you write your own winning insurance appeals. Please visit the Foundation’s website often, www.carcinoid.org, to read the latest information from Laurie. Click here to read the first installment: http://carcinoid.org/insurance/index.shtml.
When you listen to Laurie speak about fighting insurance companies it is a riveting experience. She does not use the traditional PowerPoint presentation, a slide show or a video. She captures your attention with the strength of her words and her conviction to never let anyone be denied insurance coverage for a life-saving medicine or treatment.
“What good is your best course of treatment if your insurer won’t pay?” asks Ms. Todd. She lists three reasons why insurers deny insurance claims: 1) the treatment/drug is experimental, 2) the treatment/drug is not medically necessary, and 3) you are going out-of-network.
Don’t be intimidated by the insurance company, advises Laurie, intimidate the company. If denied, the first thing to do is research the company’s appeals procedure; this, according to Ms. Todd, is your roadmap. Among the other ways to proceed are to find the company’s medical policy statement (this lists the reasons why the company will not pay for treatments) and study the definitions in the back of your insurance book. The medical policy statement is available on the insurance company’s website. You can also request a copy from the company if you have been denied coverage. Find the right decision-makers at the insurance company to whom you should address your appeal, and be sure one of them is the Medical Director.
“Purge every accusation, emotion, and feeling word from your appeal,” Ms. Todd counsels as begging, pleading, and giving into feelings do not advance your cause, they will lead to losing your cause. Your appeal is not a medical document but a legal document. At a minimum of 20 pages long, it should contain a title page, cover letter, table of contents, a bulleted list of facts, attachments, and a conclusion. The bottom line is that the claim is all about money. Conclude your appeal with a cost comparison, demonstrating how what you are proposing is less costly than what the insurance company is proposing.
The appeal is “about taking charge when you feel most victimized. It’s about dignity, grace, and winning a strategy game with the highest possible stakes,” says Ms. Todd. To gain the benefit of Ms. Todd’s experience as well as very practical tips, visit her website, www.theinsurancewarrior.com, where you can also order her book Fight Your Health Insurer and Win and CD companion piece to the book, The Sample Appeal: More Insurance Warrior Wisdom. In the CD, Laurie provides a complete appeal in MS Word format – ready to edit and use. The Sample Appeal will give you the power to choose the most powerful arguments, find the hidden decision-makers, select the most convincing proof, and win quickly and decisively.
Be your own advocate with advice from the woman who has won over 50 appeals for patients, and has never lost a case against an insurance company.