Book Art by Cecilia Levy – Happiness Between Tails
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Are you a creative novelist like me or work at anything else for which there’s never enough time? For too many people, precious moments are squandered ironing out business issues with health care agencies, stores, and all manner of institutions. The one silver lining is that any time a consumer fights for fairness, it helps everyone.
Here are some of the things that worked for me when health insurance woes added to the chaos of when I had cancer and when I injured my knee. If you’re covered through your employer, their personnel department is your mediator. The rest of us must tough it out on our own.
Before listing some of the tactics I’ve gathered that can be used anywhere and with any type of business, I owe great thanks to Obamacare. Here in California it’s implemented as Covered California (Obamacare’s official name is the Patient Protection and Affordable Care Act (PPACA), or the Affordable Care Act (ACA) for short.) Thanks to ObamaCare, it is illegal for insurance companies to discriminate against gender and pre-existing conditions other than tobacco use. Best of all, it ensures everyone is covered.
Note to Californians like me: Most know Covered California subsidizes health insurance for individuals with low incomes. (Medi-Cal helps people with zero income.) Few are aware it can broker for anyone. They’re a formidable mediator with excellent customer service! Thanks to them, it was a heck of a lot easier to work out my insurance problems.
- Above all else, stay solution-oriented and tenacious.
- Be emphatic about what you need and why. Make sure whoever you’re speaking with understands how important this is to you. Don’t settle for their doing what’s easiest for themselves.
- Telephoning, not merely emailing, achieves more immediate and thorough results. Phone when they’re least busy, such as early on weekdays or after 7pm. Forget about weekends. Even if they’re open, they’re likely to be super busy and their decision-makers are usually off-duty.
- Don’t waste time. Again, telephoning and not leaving things to just email works best. When using the phone, the moment they start to give you the runaround, ask to speak to a supervisor. If they’re totally obtuse, hang up and redial so you might encounter someone better. Later, be sure to fill out an online grievance form.
- If your grievance is not rectified within 30 days, it’s easy to file a lawsuit with the state. To learn how to do this without paying a private lawyer, google “how to file a consumer lawsuit.” In the case of health insurance, consult your broker.
- Don’t take things personally. Stay focused. For everyone but you, it’s just business.
- Refuse “No.”
- Keep notes regarding: A) who you spoke with, B) the number you dialed, the date, and the time of day, C) a transaction case ID number, ticket number, or whatever identifier they use for your interaction.
For interacting with a doctor, Kaiser Permanente offers great advice. In short, start by researching for like-minded physicians, then communicate assertively with notes and questions. Bringing a family member or patient advocate can help.
Doctors strive to be reassuring, but if yours isn’t concerned enough, use the “C.U.S.” method. State:
- C: I’m Concerned.
- U: I’m Uncomfortable with your diagnosis.
- S: My top priority is my Safety.
Also, it never hurts to get a second opinion.
Good luck! I’m rooting for you — it’ll help all of us.
Have you experienced terrible service?