Thread by @cfishman

Here's a statistic you can put to use in your daily life.

20% of health insurance claims are denied by insurance companies—either at pre-approval, or after.

Of those, just 1% are appealed by patients or doctors.

But…when patients do appeal, 44% of claims are approved.

2 lessons.
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2/ Always, always, always appeal.

The health insurance companies are counting on you giving up after getting denied—and 99% of us do give up right then.

(There are actually several levels of appeal.)

And chances are nearly even-up you'll get the treatment you need, if you just ask one more time.

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3/ I'm reporting on someone who 'appeals' insurance rejections for a living, at a doctors practice.

She says the keys to winning an argument with the insurance company are…

• Stay on the phone. Stay on hold. Never hang up. Never accept a 'scheduled call back.'

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4/ Staying on the phone creates a sense of urgency and immediacy. 'No, that's okay, I've been on hold for 2 hours — I'll just wait for the supervisor.'

• When you don't get the answer you need (or the explanation), ask for a supervisor. Her language is so great:

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5/ She says something like, 'Well, I'm sorry you're not going to be able to help me, I need to talk to your supervisor. No, I'm not satisfied with that answer. I appreciate you've done what you can. I need someone higher up. I'm sorry she's not available, I'll just hold until she is.'

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6/ Supervisor is at lunch. Supervisor is gone and no one knows when she'll return.

'That's okay. I have work to do. Send the supervisor a note or message that I'm on hold, and I'll just wait for her.'

Like that. She never hangs up.

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7/ The second most powerful tool she uses, she says, is 'why'.

'Can you tell me why this procedure was not approved? She has the insurance, this is standard, what is getting in the way of you approving this? No, 'it's not covered' isn't really an answer. It appears to be covered. What is the specific reason you are rejecting this treatment...?'

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8/ She says insisting on an explanation is often confounding to the call-center crowd — and sometimes simply leads to them saying, Okay. Because they don't know why, or can't say why.

'I don't have that information, but it is not approved.'

'Fine. Send me to the person who does have that information. Who can tell me why this is not covered?'

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9/ Again, polite but firm insistence on the most basic information.

Why?

This woman — who is a professional, talking to the 'providers' line — almost never gets hung up on.

I think we patients get hung up on routinely. But just keep going.

Also: Record your calls. Feel free to tell them you are...

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10/ 'Yes ma'am. I hope you can help me today. Just so you know, as you all are recording this call on your end, I am also recording it on my end.

'Now...'

Once they are recording it, of course — you can!

Just those two things — absolute persistence, and the question 'why' — often work.

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11/ But the time involved is insane.

The woman I'm reporting on often has single calls that last 2 or 3 or even 4 hours. Just waiting for the next level.

But she's a medical records person, too — so she does have other work she can do.

You can do that too.

The numbers are stunning.

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12/ 99% of us never appeal our rejections.

And if we did, *at least* 44% of us would get approval.

Don't settle for the 1st 'no,' or even the 2nd.

How do I appeal this rejection?
You obviously cannot help me—in fact—so please pass me up the line to your supervisor.
I'll just hold, thanks. I'll be here, waiting.

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13/ IMPORTANT SIDE NOTE:

The woman I'm reporting on never loses her cool. That's not easy for her—the kinds of conversations she has would make Lewis Carroll blush in their absurdity.

But much harder if it's your medical treatment, or your child's.

But...

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14/ Staying calm gives you a certain moral authority. It closes a huge gap they use to reject you and your appeal.

We've all been there, on the phone with the cable company or the credit card company... You start to raise your voice in pure frustration...

And they say: 'If you're going to yell, I'm going to have to hang up.'

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15/ Or, 'If you're going to use that kind of language, I'm going to have to hang up.'

In fact, yelling never works. And tbh, the people on the phone are just following their script.

You can be firm. You can even be insistent, without being rude.

'I appreciate what you're saying. You cannot help me. Now, I just need to talk to someone who can help me. Please pass me on to a supervisor.'

And so on...

@threadreaderapp Can you roll this thread up...?