How Winning an Appeal from the Insurance is Possible
When I read the research by Harvard School of Public Health stating 45,000 Americans die each year due to lack of insurance or denial of treatment by the insurance company, I said Bravo. Finally someone is doing retrospective research that reveals the facts. The facts are: insurance companies kill people. They don't discriminate who they deny treatment to. It has nothing to do with age. I have received calls for help from parents because their child has been denied coverage for treatment. It is heart breaking. The question is, can I do anything. I often can help. An advocate's job is to find the way to get the insurance company to budge. An advocate stays on the insurance company because otherwise they will drag their feet and burden you with unnecessary paper. The appeals process can be cumbersome and time consuming but it often reaps rewards. Many people don't know that after the insurance company has refused all appeals, the next step is an external mediator. This can be successful. The process is always listed at the very end of the policy. It states how to contact the necessary parties. What I have found, depending upon the state, an advocate can open doors and get a positive result.
I always advise people to look at the state Department of Insurance website and get as much information about the relevant insurance company. For instance, on the New York website, listed is the number of internal appeals per company and the outcomes. The outcomes range from 39% to 52% for the appeal . Also listed are the results from the external mediator. The results for the appeal range from 34.9% to 72%. Interestingly, the number of external appeals requested is substantially lower than the amount refused on the internal appeal. This indicates many people don't know about the external appeals process or are so frustrated they have given up. Unfortunately, it also may mean the individual has died.
I find this part this part of my advocacy work challenging and fulfilling. I am a warrior with a strategy to win the battle. Do I win every battle? No, but I do have more successes than failures. People ask me if I am worried I won't have any work if the health reform is passed. I don't worry because no where in the law does it say insurance companies have to cover all areas of healthcare for their insured. People will still need the appeals process and advocates. As an aside, I would be happy if people weren't being denied coverage and received proper care. I would find another way to be of service.
Posted by HealthCare Whisperer at 9/20/2009 11:07 AM 
Categories: insurance, health appeals, advocacy
Tags: insurance health appeals advocacy
Categories: insurance, health appeals, advocacy
Tags: insurance health appeals advocacy
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