Until recently, I was "resident Insurance Warrior" mainly for my own group -- the appendix cancer people. Long story short, I walked into my doctor's office with a metastasized abdominal cancer, and my oncologist told me, "There is no treatment for you. And, if there were, they wouldn't pay for it."
I didn't take kindly to this, found the world's expert on my cancer, fought the Clash of the Titans with my insurer, and made them pay it all.
Two years later, I run a mile a day, take no medications, and remain thus far cancer-free.
I have gone on to win between twenty and thirty of this appeal battles with people. So far, I still haven't lost a case.
The first thing I learned, when my life was so urgently on the line, not to take any of this personally. If I had given myself over to rage, while also going through two gigantic abdominal surgeries and intraperitoneal chemotherapy -- and also fighting my insurance company -- I wouldn't have prevailed, and I wouldn't have survived.
It's not personal. It is simply their job not to pay, and your job to make them pay.
I appreciate the strategy of getting the treatment first, then sueing to make them pay for it. Why? Because THE ONLY THING THAT MATTERS IS THAT WE GET OUR TREATMENTS. The terrible fights with the insurers are only a very high stakes game.
These appeals are not won based on the rightness of our cases, or on the amount of information they contain. We win them based on our ability to write an extraordinary persuasive legalistic document that makes them fear that we might be a lawyer.
What is the one power we have to make insurers pay for something they don't want to pay for? THE POWER TO SUE THEM. Why do they not want us to sue them? After all, they have plenty of lawyers to squash us like a bug. Because they don't want these lawsuits to become public record. How do you think I concocted such a smart bomb of an appeal? I spent two months poring over lawsuits against HMO's. Borrowing their scary language, copying their arguments.
Now, mind you, we aren't going to actually sue them. We are going to intimidate them. As one of my helpees who is an ex-boxer said, "Oh, now I understand! A bluff-down is as good as a knock-down." Right on brother, couldn't have said it better myself.
By the way, as more people find me, I have branched out and done carcinoid tumors, breast cancer, testicular cancer ... even a stray L & I case. Same objections, same strategy. It is the same story: If it is expensive, your insurer has a hundred secret ways not to pay for it."
For me, the monumental insurance battle turned me into a force to be reckoned with.
The Insurance Warrior is in the house.
Laurie Todd, the I.W.
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