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 slug it out on our own.
Before listing some of the tactics I’ve gathered that 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: Most know Covered California subsidizes health insurance for individuals with low incomes. (Medi-Cal helps those 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 they know how important this is to you. Don’t settle for their doing what’s easiest for themselves.
- Telephoning in addition to emailing can give more immediate and thorough results. Phone when they’re least busy: early on weekdays or after 7pm. Forget about weekends. Even if they’re open, they’re likely super busy and their decision-makers are off-duty.
- Don’t waste time. Again, telephoning and not leaving things to all simply to email is the most effective. When using the phone, the moment they start to give you the runaround, ask to speak to their 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 a grievance is not rectified within 30 days, it’s easy to file a lawsuit with the state. To learn how to do this without having to pay a private lawyer, google “how to file a consumer lawsuit.” In the case of health insurance, your broker can advise you.
- 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) number you dialed, date, and 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 they don’t seem concerned enough, use “CUS” by stating:
- 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.
How do you get better service?