INSURANCE COMPANIES

It is not easy to raise a "special needs" child, and often little or no cooperation
from your insurance company.

I remember someone once asking me if "do you ever just cry" because of
all the challenges we are faced with raising our beautiful little girl.
And I remember thinking about it carefully and responding to her that
"the only time I ever cry is when I have to call our insurance company".

I believe and I stress this is my opinion, but I believe that insurance
representatives are taught to make sure they do not make it easy for us
to get repeated coverage. I believe that we are "tagged" early on as a
"try not to pay" client. And I believe many people are not aware of how
to fight for coverage.

We go to special doctors, and many of them. These doctors tell us what
our daughter needs to improve her life. Whether it be speech therapy, or
augmentive communication, or whatever. We call our insurance company
and they tell us why they can not cover it. It doesn't matter if it is
listed as a covered service, and it does not matter if is listed as an
exclusion. An exclusion is something that your policy specifically lists
as something that it will not pay for. If it is something your doctor
recommends, there are steps you can take to get the bills paid for by
the insurance company.

I learned of this method from a Reader's Digest article. It suggested if
it something you medically need, first you should put your requests in
writing. Always put it in writing. This is documentation they can not
just ignore. Remember they can pretend that you never called. Give your
insurance company a chance to respond to your requests. This will
usually occur with in a month or so. If they turn down your request,
don't give up, you have another option.

All of us in the USA have a state government office dedicated to
overseeing insurance companies. Put together a letter to your states
insurance department, include in the letter the name of the insured
person needing the coverage. Include the insurance ID number that your
insurance company will recognize. Give an accurate description of what
your medical needs or prescribed therapy or equipment may be. Ask them
to evaluate your needs and the needs you are not having met by your
insurance company. I recommend you make a copy of this letter and send
to your insurance company and your prescribing physician. Send all three
this letter.

Each time I have done as I described it has taken about one month of
evaluation of the situation. Every time, it has resulted in a positive
answer to my request. One of these requests was for medical equipment
that was a "listed exclusion" to my policy. They paid for it anyway
because the state asked them to do so. The states theory is, if it is
needed then an insurance company should make every effort to pay for it.
Although my experience has been that more time is spent trying not to
pay.

I met a man who had worked for years for a large insurance company, and
I told him what I had learned about fighting his big company. He told me
it was common practice within the company that if a client had made
contact with the state a few times, then you should "just cover them".
They receive a blemish on their file each time a client contacts the
state about their company. So it to their advantage to take care of you
so that you won't involve the state.

I have found this procedure very useful. And if you can learn to fight
with the big insurance companies you can fight and beat anyone.

Sincerely supportive,

Phyllis (Lily's Mom)