Insurance Appeal Update

Yesterday I went all the way up to Mountlake Terrace, Washington to present myself before the Premera appeals panel. I got there right on time, was well dressed, and a bit out of place with my pink/purple hair. I wore heels just to make me a little more fierce and ready for action. I went to the desk of building one, and presented myself. There was no badge for me. After some calling around, the desk person found the people I was supposed to meet with, and about 10 minutes later, a woman came out, looking perfectly present, and let me know they weren’t expecting me.

I suppose they get that a lot. The way that the second appeal process works is that you write a second letter of appeal, and they send you back a letter for a formal meeting, during business hours, either at their offices or by conference call. I’m sure that most people take one look at that letter and throw it in the trash, giving in to defeat. After all, the offices are far away, and if you’re working (or very ill), a conference call is intimidating.

They quickly assembled the panel. Two were in person, a moderator and a claims analyst. Then there were two on the phone, a physician and another person, whose role I have forgotten. She spoke the least of all of them. What I had expected to be intimidating, was totally not. These people kind of acted like they wanted to be my friends. Well, you know, the kind of friends you make in an hour at a party and never see again.

They gave me the chance to say why I was there, and what I wanted. THIS WAS MY BIG CHANCE. I spoke eloquently and succinctly my primary reasons for being there. The bottom line being that I was misled and/or uninformed by my insurance company and Swedish Medical Center – Ballard/Ballard Emergency Physicians as to whether or not my emergency care would be covered as in-network. I walked in with about $550 at stake, and in the end, I realized I asked for a couple million dollars instead.

When I realized what I had done, I was driving home, and I just couldn’t stop smiling and chuckling to myself. To the largest insurer in the State of Washington, $550 is a drop in the bucket. That money would be very easy to just give to a person to make a problem go away. Apparently, that’s not what I wanted. What I asked them for, in the end, was a policy change. I asked them to change the information available to their subscribers so that people like me (and others) would not have to go through this. It’s so people, when they have the choice as to what ER they go to, can choose one that is in-network. I asked them to inform and educate their subscribers, and have that information available to their telephone representatives. The cost of a policy change, and all the subsequent paperwork, updates, mailings, legal consultation, and on and on and on to do what I am requesting far exceeds my $550 that started all this.

I should have just laid out my request, stuck with that, demanded full payment of my charges, and walked away. But no. In true Q style, I used the open door to demand a revolution, with no army backing me, and no reason for them to grant my request.

In the end, I believe that I had a human experience with them, in a very inhumane system. The workers I dealt with, as cogs in the evil machine, seemed genuinely compassionate, but locked in inertia as the machine moves on.

Let me impress to you: MAKE YOURSELF HEARD. It may seem futile, it may seem a complete time and energy suck of a battle. That’s what keeps the system as it is. Write your state legislators, write Congress, write your insurance companies, your doctors, let them know that you are more than a patient ID number.

I will also note with that (because these things should go without saying, but unfortunately, it needs to be said) – make yourself heard within the limits of the law. Keep a cool head and learn to use the system resources to your benefit. Every road block is an educational experience. Share what you learn. Make a difference.

We’ll see what happens – I should hear the update from Premera in the next week or so.

See previously: Emergency Room Charges, Ballard Emergency Physicians and Swedish Ballard Emergency Room, Insurance, Emergency Room and Complaints/Appeals.