​Health Insurance Denial Appeals Process – You are Your Own Best Advocate

Posted by Reeve Staff in Life After Paralysis on August 07, 2020 # Insurance

By guest blogger Ali Ingersoll

Living with a disability can be fraught with uphill medical and personal complications. Despite the seemingly insurmountable challenges facing a majority of us, one strategy that enables us to see the forest beyond the trees is to band together through advocacy and camaraderie. When we support one another by working together to effect change, everyone wins as we live our best lives with dignity, elegance, and grace.

I was injured in a shallow water diving accident in 2010, leaving me a C6 quadriplegic. A part of me died that day, and it took many years of self-work to bring me to who I am today. I spent the first six years of my spinal cord injury (SCI) life in and out of hospitals dealing with pulmonary embolisms, cervical cancer, and undergoing various surgeries for pressure sores, spinal cysts, and broken bones. Ali Ingersoll

They say it takes a village to raise a child. In my case, it took a village of family to see me through my darkest times. After overcoming the physical challenges presented before me, the next mission in my life was to overcome the mental obstacles. It took an incredible amount of hard work, determination, perseverance, and support to come out on the other side, living life with a spinal cord injury and with purpose. That is exactly what I did and continue to do to this day, which has led me down the road of advocacy for those who cannot advocate for themselves.

I find the best therapy for life is a dose of humor, mostly dark at times, but humor none-the-less.

With that said, I try and approach all challenges in my life with grace, elegance, and humor - even when it comes to dealing with insurance companies!

Over the last ten years, I have been in continuous battles with my health insurance company in the fight for "medically necessary" equipment. I have learned to navigate the winding appeals process strategically. I've quietly engaged in these missions, but in January 2020, when I was finally eligible for a new power wheelchair, I decided to take the wealth of knowledge I had gained over the last decade public by helping create a road map for SCI folks to win their insurance battles.

I was denied a critical function of my power wheelchair called the seat elevator. The seat elevator is critical for my daily safety when I am left alone at home for hours, without a caregiver because insurance will not pay more than 60 hours a year for home health services. I do not qualify for Medicare or Medicaid, so I am constantly duking it out to make sure I have the right equipment to keep me safe.

If I stay in-network with my providers, I pay about $13,000 a year for health insurance, and that would be upward towards $30,000 per year if I choose to use out-of-network providers. With that said, I firmly believe in fighting for every piece of equipment. Most insurances claim that their reason for denial for a piece of equipment is because it is a convenience and not a medical necessity. Insurers have several levels of appeals, but if they send a final denial letter stating that all internal appeals have been exhausted, one has the right to go to a state's Department of Insurance to file an external review. The external review board can overturn an insurance company's final denial.

When I was denied the seat elevator, something inside me snapped in the most positive of ways where I wanted to take my advocacy mission national. I'm now working with incredible disability organizations to create a national campaign to help others navigate the appeals labyrinth, whether that be through a private insurance company, Medicare or Medicaid. We have rights, but insurance companies make it tricky to figure out how to best self-advocate. While we are faced with a systemically broken healthcare system in the United States, we still need to work within the system until real change occurs.

I've written detailed articles for Push Living Magazine on the specifics of my last insurance battle and how I won my seat elevator last month. In short, ferocious determination and persistence were key. I also have my own website (www.quirkyquad.com) on a variety of topics, including advocacy, sexuality, life in a wheelchair, love, marriage, and more.

In my next article, I will outline several calls to action to assist my fellow spinal cord injury community in advocating for themselves when dealing with insurance denials. For more information, read Part 2: Navigating Health Insurance Appeals – Call To Action.

About Ali

Ali Ingersoll is a day trader, consultant, disability advocate, writer, blogger, editor, and public speaker. She started her advocacy mission after being repeatedly denied medically necessary equipment by insurance companies over the last 10 years. Ali's passion lies in coaching people with disabilities on how to improve their quality of life by teaching them how to self-advocate in order to live a life of independence, dignity, and grace.