Fighting the Health Insurance System

One of the things that frustrates me most about health insurance: when you need it most, you’re less able to deftly navigate the system:

“You have the right to independent medical review, but how good are you going to be at taking advantage of it if you’ve got cancer?” said Dustin Berger, an attorney in Wyoming who has written about health insurance appeals.

Every health system rations care one way or another. And some might say that a warrior like Todd is sucking the system dry. To her, that analysis is backwards: She believes she gets patients the treatments that have the best chance of working, instead of wasting their time — and the insurers’ money — on endless rounds of less effective interventions.

“People say, ‘The insurance companies might come and torch your car,’” said Todd, laughing. “But I’m the insurance company’s best friend. I’m saving them hundreds of thousands of dollars by finding the patient the best treatment for them.”

It’s true, though. My experience with insurance is much the same thing–you have to try and fail and try and fail and try their list of treatments one by one until you can finally level up to a treatment that might work. Even if you have documented evidence that you’ll need to skip from level 1 to level 4 to effectively treat, they don’t let you.

That is the problem with large systems like insurance or with “scripted” walk-in clinics like ZoomCare*. You are not an individual person to them, you are an input. And, as one of many different inputs, you’ll get routed as appropriate until you reach the end stage. It takes a massive amount of startup energy to eject yourself from the pre-programmed channel into being as a real person with a real problem.

That’s why Laurie Todd personalizes her stories. That’s why she goes straight to the top, the people who can make decisions and pull files out of the routing system. That’s why she waits until the last week, when she can light the issue on fire and lob it into the appeals board and make a big bang.

To tackle the biggest problems, you really do have to go outside the system. Either you go alternative, or you fight with someone like Laurie Todd on your side. I suspect we’ll be seeing a lot more Laurie Todds in the future.

 


*ZoomCare is great, don’t get me wrong, but usually for clear-cut issues that only need a rubber stamp treatment.

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