How to Work with Health Insurance Companies and Providers

My husband survived 3 kinds of cancer. Some people, even doctors, call him a miracle because he's healthy and still here. We were both in this fight together. While he and his doctors fought the cancer battle, I and my allies battled the health insurance war. I am very happy to say that both our sides I won the battle. He beat his cancers, and our health insurance claims were paid.

Through this experience, we learned a lot. We both learned many things about cancer, and I became educated on how to work with health insurance companies and providers.

His first cancer was cancer of the larynx. His surgery went well, and after about 3 weeks in the hospital, he was home. Things were going fine until I came home for lunch from work one day, and found an envelope on which he had written "If you are in a good mood, don't read this." Well, of course, I read it; it was a letter from his insurance company informing us that they would not cover him for his cancer because it was a "pre-existing condition." Good try, insurance company!

About the time I read the letter that day, the sky turned dark as night, and a huge, and I mean HUGE, hail storm was upon us. So, here we were after the storm, walking around the neighborhood looking at the damage with all our neighbors, knowing that our house and vehicles were damaged as badly as the others (the roof was trashed, vehicles badly dented),and we didn't even care about that at that moment. All we could say was "the insurance company says he isn't covered for his cancer treatment!"

I called in the big guns; I phoned my sister-in-law, who just happens to be a lawyer, and told her, "Remember when you said just to ask if you could do anything to help? Well, there is something we need." To make a long story short, thanks to a letter from her on her law office letterhead and a law that says the company can't deny a "pre-existing condition" (which it wasn't anyway) if insurance coverage was continuous, we got the insurance company to change its mind, and they paid the bills.

The next year, he was diagnosed with small cell lung cancer (a very aggressive cancer) and kidney cancer. Enter a whole new bunch of providers, and thank God for each and every one of them! Still, the bills needed to be paid, and to see that every one was submitted and processed correctly to two insurance companies (yes, we were incredibly lucky there) was a big job. There were no other takers for this job, so it fell to me.

This is how I did it without completely losing my mind:

1. Record and follow every bill. When a serious illness occurs, it isn't like it used to be. There are many providers, and many do not do their own billing, so you might be dealing with a second or third party in a different location when it comes to the actual insurance filing or billing. You might give the insurance cards to the provider, but if whoever files the insurance doesn't get it, it doesn't get filed with them; then whoever bills you assumes you owe the entire bill. If you want to avoid being billed for items that should have been paid by insurance, you do need to do this.

2. Make friends with the providers, billing personnel and insurance processing people. Be nice and friendly when you call them; it helps! I got so I knew when their babies were coming, how old their children were, and even how they were feeling that day. Feeling like I cared about them made them want to do a good job for us, too.

3. Keep good records. I had a spread sheet for each provider's bills on the computer, and recorded information each time I received it. That made it easier to see what had been paid and what had not, and saved the nightmare of sorting wildly through stacks of paperwork.

4. Keep every piece of mail too, and organize it. I used a 3-ring binder with a section for each provider. That made it easy to find a specific item.

5. Find people who know the "system" to help. Informed helpers are essential. I had my niece and a friend, both of whom had worked for insurance companies. They were a great help in assisting me to understand the procedures.

6. Try to make sure everyone has what they need. Don't assume one provider will send the information along to another, even within the same facility. If an insurance provider or plan changed, I made copies of the new cards, sent them, and made sure whoever does the billings got one too, and sometimes followed up with a phone call just to make sure.

7. Question everything that is not paid promptly or that doesn't look right. This is essential; mistakes happen. Ask questions. Stand your ground if you know you are right. Send documentation.

8. Make payment agreements for whatever part you do owe. Providers are usually eager to work with people. Be assertive, and call them before they have to call you. Assure them that you plan to pay the bill, and make a payment plan. If they don't hear from you, they will turn your bill over to collections, and this will affect your credit.

9. Relax. This was the hardest part for me, and I can't say I did very well. I did a lot of worrying and stressing.

10. Realize that this too shall pass! Eventually, he did recover from all 3 cancers, the bills showed down, and everything returned to as close to normal as possible. It was a blessing; we were one of the lucky ones.

By the way, the hail storm proved to be beneficial. We needed money just then, and with 3 dented vehicles, we opted to just total them out, buy them back from the company, keep the cash, and keep driving them. For years, people would see my car and say, "Wow, you were in a bad hail storm!" Yup; we sure were, in more ways than one.