What does it mean to ‘fight an uphill battle?’ The idiom definition is, to struggle against very unfavorable circumstances. (I think the keyword here is ‘very.’)
Have you ever had to file an appeal against your insurance company for denied medical claims? It is a ‘very’ upsetting process! One that can make a person feel sick or injured all over again.
Having been diagnosed with severe rheumatoid arthritis at the age of 21, I can say I’ve spent my entire adult life learning (in some cases, the hard way) how to properly file medical claims and appeals. One lesson that’s been the hardest is, even when I do it right, I’m often told it’s wrong.
Although I’m grateful to have health insurance and appreciative of the benefits, there have been times when it’s felt as though the uphill battles (yes, plural) have been the most challenging experiences of my life. In fact, I’ve labeled them as secondary illnesses to RA because of the sick feeling I get when seeing those six letters, “D-E-N-I-E-D.”
After September 23, 2010, those of us looking up at the hill will be told that we will be armed with new tools created to ease the battle somewhat. Under the health care overhaul law, new regulations increase our rights to appeal denied claims. The new process also applies when coverage has been canceled.
Previously, patients’ rights to appeal varied by state and insurance company. Under the new regulations, patients can challenge ‘adverse benefit decisions’ (denials, terminations or failure to provide payment for benefits) by choosing an external review or independent reviewer not affiliated with the insurer. Every state will be required to have a process for external appeals making it more consistent.
On paper, the overhaul law looks good and is a step in the right direction for anyone facing this battle. However, in my opinion, when it comes to daily living, the new process doesn’t ease the symptoms of being denied necessary coverage.
As the patient, I will still experience the sick feeling upon seeing those six letters. And my symptoms will not subside while making the dreaded calls, completing the paperwork, filing the appeals or the time spent waiting for a decision, all in an attempt to convince a review board that I really am as sick as my medical doctors and records indicate.
To read more about my battles, see blogs, “Denied Medical Claims” (9/13/10) and “Health Insurance” (3/30/09).
Have you had to file appeals for denied medical claims? What were the results and how long did it take for a decision? Was it reversed or denied again? Do you feel the changes in the overhaul law are beneficial to patients filing appeals? Please share your thoughts in the comment section below.
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