Fighting the Health Care Bureaucracy: Our Personal "David and Goliath" Story

I had known about the mole on wife's back since before we were married. It was about the size of an eraser on a pencil, and had always been raised and irregularly shaped. She had always been self-conscious about it. By late 1998, it had migrated about a quarter inch toward her shoulder and changed color from pink to almost mauve, the texture becoming close to that of cauliflower. After much pestering from me, she finally went to our doctor to have it examined, and he immediately referred her to a dermatologist.

The mole was immediately removed and tested. The news was indeed terrifying; the mole had metastasized into a stage two malignant melanoma. She had also developed a benign lipoma underneath it the size of a beer can. It can be safely assumed that we did a lot of praying when she had not only the lipoma surgically removed, but also a chunk of skin and muscle about one cubic inch thick to be tested to make sure the cancer had not spread.

Thankfully, neither the lipoma nor the tissue surrounding the melanoma showed any sign of cancer. The doctors all told Luchrisa that I had literally saved her life. I don't know what I would've done if I had lost my beautiful wife after only 5 years, and I thank God I bugged her until she went and had it looked at. After over a dozen staples and twice as many stitches, we could now deal with her long, painful recovery.

Of course, we made sure I filed the appropriate claims forms from my employer's insurance. They had given me no literature for filing claims, and when I went to my Human Resources office at work, they kept giving me the runaround. They claimed to only have one book, and said they would not give it to me. I replied that it was fine with me, and I would just stand there in the HR office until they copied it for me, page for page.

For about an hour, they tried ignoring me, but I would not yield with my wife's life in the balance. When they finally realized that I wasn't going back to my machine until I got that insurance plan book, they reluctantly copied it for me, page for friggin' page, just like I asked. I took it home and filed the claim forms that I was required to file, and gave the other information to the hospitals, and scraped together a cool grand for the deductible. I figured since we had taken care of the red tape, we could focus our energy on Luchrisa's recovery.

You'd think so, wouldn't you? Almost immediately after her last checkup, the bills started coming in. We kept checking with my company insurance on the status of our bills, and they kept insisting they were being paid, and not to worry about it. As the months rolled by, the mounting hospital bills turned into threats of garnishment and lawsuits. All this on top of the humiliation of the Human Resources department at my work treating me like some vagrant at the door of their mansion, begging for crumbs, whenever I needed answers was starting to get me very angry, and the warrior in me was rising like a phoenix!

I called the insurance company and demanded to know why they weren't honoring our agreement and paying my wife's hospital bills. They explained that since they were a third-party provider, they needed permission from my employer to pay the bills, and my employer was denying payment for any claims we filed. So then I marched straight to the HR department at work the very next morning, and told the nice lady there what the insurance company had told me. She replied that they were lying to me; that it was THEY who were denying the claims. She suggested I write them, and tell them what she had told me, only to be told in a letter, once again, that it was my employer's fault that our account was in delinquency.

I was really getting tired of this blame game they were putting us in the middle of. The hospital was holding us responsible because the insurance was not paying what they had promised. I was SO ready to fight, but really didn't know how; after all, I was just "trailer trash", and couldn't really afford a lawyer, and all the rich people in this scenario were counting on me to just roll over and start paying to keep their meathooks out of our paychecks. I had reached the point of despair, until my father-in-law gave me some of the wisest advice I ever had; good "poor-man's" advice from a man who's been there before that went a long way in solving this dilemma.

He told me to make three copies of every bill, threat, and piece of correspondence from the hospital, the insurance company, and my employer's HR department, and to put one copy of each item into three large brown envelopes. Next, I was to send via certified mail (return receipt requested) one packet to a specific person in both my employer's insurance firm and their HR department, each containing a cover letter explaining to them that they both had been mailed packets with identical contents, and that a third packet existed, which would be going to an attorney if these bills didn't start getting paid immediately.

Well, miracle of miracles, if THAT didn't get their attention! The very next week, my wife's hospital bills were being paid, each new day at the mailbox bringing several statements that were once marked "Bill Past Due" and "Account In Default" now marked "Paid In Full"! In the end, there were only about $4,000 worth of bills we had to pay ourselves, but that was way better than the $45,000 we initially were being hounded for. I mean, why bother paying for insurance if it isn't going to pay for anything?

It took almost a year of working overtime to pay them off, but it was an awesome feeling of accomplishment. About a year later, I got hit with a fourth round of layoffs after over 4 years on the job, and I am quite sure it was punishment for fighting back against these unfeeling corporate bureaucrats, because I was there every day, on time, out sick only once, and out-produced everybody in my department. That didn't hurt us one bit, though, because we will always land on our feet, because we are always willing to work anywhere until we reach our dream goal of self-employment. No Godless corporation is going to make or break us!

Because she is red-haired with clear skin, she is in the highest risk group for skin cancer. She goes for regular checkups every year, and has been cancer-free ever since. In spite of that fact, no private insurer will touch her with a ten foot pole, because she had it once. Even if we could afford our own medical insurance, she is, for all practical purposes, uninsurable. Even if she lives the next 50 years cancer free, the black cloud of this evil disease will always loom over our lives, therefore, at least one of us will always have to have a 9-to-5 job, because at least there are laws prohibiting employer group policies from denying coverage to anyone because of past medical history, and having no coverage at all is not an option!

I hope others can learn from our experience in dealing with these cretins. First and foremost; DO NOT EVER STOP FIGHTING! That's what they are hoping happens, because they are only interested in a walk-away victory. Ask questions and demand answers. Get names, titles, and departments of every single person with whom you deal. Call them, write them (registered or certified mail only), E-mail them, and show up at their offices in person. Hammer them every bit as hard as they do to you, and they will know they aren't dealing with a pushover!

Make copies of everything. Mail everyone involved copies (NEVER originals) of every transaction and piece of correspondence, and make sure all written correspondence requires a signed return receipt so they cannot lie about getting your letter. Be sure to keep another packet of the same copies for a lawyer, if it has to go that far; many will take such cases on a contingency basis if you cannot afford to pay upfront. Pay only in check or money order, make copies of all payments, and keep every money order stub and cancelled check. Keep and make copies of every single "Paid In Full" or "Account Settled" notice you receive.

Finally, keep everything associated with your ordeal, originals AND copies, in a fireproof box for at least seven years. These ruthless barracudas have been known to dig up old settled debts and try to get more money from you. If you don't have proof that you paid the account in full, guess what? That's right, they will sue you, and they will win unless you can very quickly produce that proof. Hopefully, you won't have to go through what we did. It could've been a whole lot worse than it was, but as long as you keep a cool head, use common sense, and understand that their threats and stonewalling are just psychological tactics designed to intimidate and frustrate you into waving the white flag, you can come out of your fight with the health care bureaucracy victorious!