Navigating Health Insurance Appeals – Call To Action

Posted by Reeve Staff in Life After Paralysis on August 10, 2020 # Insurance

By guest blogger Ali Ingersoll

Over the last ten years since breaking my neck in a shallow water diving accident, leaving me a C6 quadriplegic, I have undergone many hardships and triumphs and developed a "thick" skin when dealing with insurance companies.

In my last blog post, I discussed the insurance denial regarding my seat elevator for my new power wheelchair. I won my battle, but it was not for lack of trying. Whether you have Medicare, Medicaid, or private insurance -- You Have Rights. Finding success in accessing medically necessary equipment is a function of understanding the steps within the winding appeals process.

Most insurance companies don't want you to navigate through their appeals process. Too often, folks accept the final denial and leave it at that. Insurance providers are the ones who have created the appeals labyrinth that seems impossible to navigate. I assure you it is not. It does take advocacy on your part, and while I am presently working on creating a detailed roadmap in the long term to help folks get the medically necessary equipment they need, there are several steps you can take right now to be your own advocate.Ali Ingersoll

1.Understand Your Rights

The rules vary depending on whether you're covered by private insurance or a public program, but in general, you have the right to appeal anything. Thoroughly read the steps within your appeals process and make sure you are two steps ahead of your denial letter. Equip yourself with knowledge and take the advantage away from your insurance provider because the most significant thing they have going for them is confusion.

You also have the right under federal law to reach out to your insurance carrier's HIPPA compliance officer to ask who reviewed your case. Often, these reviewers don't have specific knowledge of your disability. This can be to your advantage in the appeals process because you can argue that your reviewers are not medical "experts" in your field of disability.

2.Create Strong Allies

You are not in this battle alone. Your medical professionals, such as PT's, DME providers, and GP's, are there to help you. Be sure to foster personal relationships with them as they are the ones who are going to write the most powerful letters of medical necessity for you. It's important to note that you know your disability best, so guide them in the process of justifying why you need a certain piece of equipment is a powerful advocacy tool. They will follow your lead if you work with them.

Make sure that whatever piece of the medically necessary equipment you need has a specific medical code attached to it. This is key because if there's no code assigned to a piece of equipment, likely it won't get approved. Also, be sure to double-check that your medical professionals have assigned the proper code the equipment you are trying to attain.

Most importantly, be aggressive, but be kind. I call it being pleasantly persistent. Many of these medical professionals are very busy. They have many patients, so making a schedule to follow-up with them regularly to ensure they submit what you need for your appeal is very important.

3.Going the Extra Mile

If you don't feel you're gaining enough traction through the appeals process, you can take your battle a step further. If you are denied potentially life-saving equipment, it can make an excellent human interest story for your local news organizations. Type in a quick Google search of investigative reporters in your local news outlets and write them an email. You may be surprised who reaches out to you.

In my recent battle for the seat elevator, my story was picked up by the North Carolina News & Observer as well as a TV segment by ABC 11 news.

Take it a step further. Write a letter to the CEO of your insurance company, reach out to your local elected officials to share your story, and contact your local disability organizations to help you.

Every effort counts. Sometimes you need to throw as much mud at the wall to see what sticks

It's easy to feel isolated when you are dealing with all that comes along with a spinal cord injury or disability, but remember you are not alone. There are so many incredible resources out there, organizations, and people willing to help if you just ask. As my father taught me - the worst one can do is say no, but if you don't try, you will never know.

To reiterate from my last article, I've written detailed pieces on Push Living Magazine detailing my last insurance battle on how I won my seat elevator last month. In short, ferocious determination and persistence were vital. I also have my own website (www.quirkyquad.com) on a variety of topics, including advocacy, sexuality, life in a wheelchair, love, marriage, etc.

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 ten 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.