I'm giving our insurance co. credit for all of my grey hairs. Wonder if I can claim getting my hair colored as a medical expense? Seriously though, dealing with health insurance companies can cause you to lose your mind....but then you'd be stuck having to deal with them to pay for the treatment of your mind. Unfortunately we've dealt with them way too much, but through it all I've learned valuable information that hopefully can help save you time...and your mind.
IT'S NOT PERSONAL...IT'S BUSINESS
First things first...remember that your health insurance company is a business. They are out to make money. Like all successful companies, they make a lot of it. Millions of dollars in premiums are paid each year to health insurance companies who make money by spending as little of the money you give them as legally possible. .
HAVE YOUR DUCKS IN A ROW
It's always best to have everything in writing. If you have a contact email...use that instead of calling. Although all calls are recorded, you will never get the same level of attention if it's not in writing. Having a paper trail is one of the best defenses you have if things go awry. If you do need to call make sure you are prepared. Here are a few tricks I've found helpful.
KILL THEM WITH KINDNESS
After you listen to a hour of smooth jazz, and press 40 prompts you finally get a live human to talk to. I know this may sound totally contradictory but although the random human who picked up your line works for your health insurance company and is doing their job....they are, in fact, human. It is not their fault your claim was denied, or whatever the reasoning it is for your call. Ever hear the phrase you have to give respect to get it? Yeah, unfortunately this applies to insurance agents too. That person is your only link to getting what you need. You will hit a brick wall if you call yelling and screaming. So what can you do?
NO SAY.... NO PAY
We actually had this situation come up 2ce with Emma last year. She had a muscle biopsy done that was ordered by our Neurologist to have some genetics testing done. The Anesthesiologist our hospital used wasn't in-network with our insurance company nor was the lab that did the testing. Our insurance was billing under out-of-network. This is a big NO, NO and your insurance knows it. If you chose a doctor etc that's out-of-network, then that's on you. You are not legally responsible for anything you didn't have a say in. They will try to pull one over on you, and unfortunately some people just pay up.
MAKE SURE IT MATCHES
Before you pay a dime of your bill make sure you have your EOB that goes with that bill. Make sure the bill from the provider and your patient responsibility on your EOB matches. Especially if you're dealing with thousands upon thousands of dollars of claims...things get messed up. Providers like to jump the gun before they get a response from your insurance co. Sometimes they guess you have a deductible that hasn't been met, or a co-pay. If your EOB has anything that shows it's a non-covered service...ask about it. Sometimes coding is wrong, or other human error. They can always resubmit the claim.
APPEAL...APPEAL AND APPEAL AGAIN
Your doctor orders a procedure, test, treatment, etc. and you get a denial form letter in the mail from your health insurance company with the typical denial jargon. According to the denial letter the medical expert that is hired by your insurance company that denied your claim found your claim not be medically necessary, or the test is experimental, diagnostic, or the test won't change your course of treatment. Here's some things that you can do to try and get what you need approved by your insurance or your doctor wouldn't have ordered it in the first place.
Most importantly, be persistent. You are your, and your child's best advocate. It seems unfair that with everything you are going through, that the added stress of health insurance is another burden to carry. Don't let it break your spirit. Persistence does pay off. Use the stress you feel against your health insurance company as fuel to fire your determination to fight for what is best for your health and your child's. Hang in there...I'm fighting along with you.
I was told by another mom while Emma was in the eating disorder partial hospitalization program a great example of the meaning behind the importance of self-care that will be forever engraved in my mind. She said.... "life as a care taker is like a flight attendant's safety instructions when you board a plane. You know, those instructions that everyone ignores...too busy with the other details of life...checking emails, sending texts, checking in on social media...etc. etc. etc. In case of an emergency and the oxygen masks fall the attendant tells you that if you're traveling with a child to put your mask on first before you put it on your child."
WAIT...WHAT?!? This goes against everything within our nature not to take care of our child first or anyone first for that matter...but the consequence on a plane is obvious. If you're passed out from no oxygen, you can't take care of your child....you both die. Self care is not selfish...it's a necessity.
Whether you're a caregiver, receiver of care, or just a human interacting with other humans...self-care applies to everyone. No matter what your life's journey looks like. It has been a LONG time that I personally have struggled with the concept of self-care. Yes, I'm learning to practice what I preach for self-care. It's easier said than done. I'm a work in process, but I'm proof if I can implement this concept anyone can. Emma's monthly self-care journey subscription boxes in her store are a great way to start. Little examples of what we've found to be helpful...hopefully we can help you too.
Fight or Flight
Why has self-care become such hard concept for us to adapt into our daily lives, and instead we seem to live fearfully and over-stressed? It's important to understand how your body and brain work together, and understanding helps make the adjustments in your life that best fits you. One of the main reasons self-care seems to be put on the back burner of life is because we live with our brains in fight or flight mode.
Your body's fight or flight response is your body's response to threat or danger. During this reaction certain hormones like adrenaline and cortisol are released, speeding your heart rate, slowing digestion, constricting blood flow to major muscle groups, and changing various other autonomic nervous functions. This gives the body a burst of energy and strength. Originally named for its ability to enable us to physically fight or run away when faced with danger, like running from a saber-tooth tiger. It’s now activated in situations where neither response is appropriate, like in traffic, during a stressful day at work, or dealing with chronic pain and illness. When the perceived threat is gone, systems are designed to return to normal function via the relaxation response, but in our times of chronic stress, this often doesn’t happen enough, causing damage to the body. We are so busy trying to "fix and solve" problems, situations, and other humans that we get stuck in a doing-mode. Our minds and bodies are in a constant fight or flight response.
So how to we switch this off...we must try to switch from a doing-mode to a being mode. We must be present, be mindful. You will continue to have difficult days....a lot of them. Practicing self-care allows us to practice self-compassion. Be compassionate with yourself, but be aware of your responses and it's effects on your complete self. Don't label your emotions as good or bad....accept them, all of them. Cry when you need to, laugh when you can, and love often.
Welcome to my daughter Emma's medical journey blog. Read updates on Emma and helpful tips for researching and coping with a child with an unspecified, rare genetic disease living in chronic pain. Click on the ABOUT tab to see how her journey started.