BY SUSAN ESTRICH
But there is one thing I am very, very good at, by necessity.
I know how to fight with insurance companies.
My sister, who was head of group claims for a major insurance company [in her early 30s, when she herself had cancer], taught me some magic words to throw around, like reporting to the insurance commissioner. Over the years, I learned more magic words. I volunteered to help my friend, a secretary in my office whose back surgery was suddenly “disapproved” two days before. I found the medical director. He hailed from Harvard. “I’m sure we know each other,” I said, since I hailed from Harvard, too. And I was a nationally syndicated columnist and paid TV talking head. Twenty-four hours later, she got her approval.
And then it happened to me. Twice.
For 10 years, my arthritis stayed mostly in remission. We would blast it out with Enbrel [a biologic drug] and methotrexate [an early chemo drug], and most of the time, even though my numbers weren’t good, my body was fine.
Until the new insurance company decided it needed more preapprovals. Ten years on medication – not enough. Blood test results were not enough. Letters from two doctors were not enough. The third party who my accountant hired to “help” me had no clue; every piece of information they gave me was wrong.
I finally got my meds, two months and about 10 phone calls [by me] later. The insurance company saved $10,000. My hands still hurt.
Rheumatoid arthritis is painful. Untreated, it can permanently destroy your joints. But RA doesn’t terrify me near as much as heart disease and cancer.
That came later. I have an MRI every year to monitor the aneurysm in my ascending aorta. Thanks to the brilliant Dr. P.K. Shah, I’m on the right medicine, and it’s been stable. But being the sort of thing that can kill you [and almost killed my brother], I’m religious about the need for annual monitoring.
Not so my insurance company. It took weeks to get the MRI approved. When I finally had it, I [being a little stupid about such things] asked the tech how it looked. “Your heart looks fine,” he said cautiously. “What doesn’t look fine?” the lawyer in me asked. “Your lungs.”
I lost my best friend to lung cancer. I smoked cigarettes until I was in my 30s. I had my first scare a few years ago. Benign. “Are they new shadows?” I asked the tech, who realized that he had said too much.
It was enough. I called my lung surgeon, Dr. Robert McKenna, the best in the city. His wife, a wonderful woman who runs his office, put in the request for a CT scan as soon as the pictures got through.
Days passed. The insurance company told me it was waiting for the information it had received days earlier. We sent it again. It said it should have an answer to my request “soon.” What is soon? Shadows in both lungs?
The fight was on. It took me all day. The insurance company had outsourced the preapproval to a third party. Every person I talked to read me a stupid script, wouldn’t give me the contact for the medical director. It was impossible to figure out who the general counsel was.
The one department you can always reach at a big company is PR. It’s 24/7 access for reporters, in theory. No one answered the phone. So I left a message. Very simple. Would you prefer a syndicated column? Would you prefer I call one of my pals who runs a network news division? Or how about if I just get on TV myself? Let me know what you prefer.
Within an hour – and it was night in the east – the medical director emailed me: Dear “Professor Estrich.” Harvard. The nice man who helped the secretary. The general counsel called. The approval came the next morning. The CT was clear, thank God.
But here’s the point, the one they didn’t want to hear. What if I weren’t a Harvard professor? What if I didn’t have a syndicated column? What if I hadn’t spent 30 years as a TV talking head? What if I didn’t know the magic words? What about my brother, who is none of the above but seriously ill? What about the 99% of the world who doesn’t know how to play this game?
You shouldn’t have to be a Harvard professor who can deliver a credible threat of terrible publicity to get the coverage you paid for and the care you need.
It’s wrong. But you have my permission. If it happens to you, pretend you’re someone just like me. Or tell them I’m your cousin, the troublemaker. Otherwise, you might still be on hold.
– Susan Estrich’s columns appear regularly in The Oklahoma Observer