Ask the Insurance Warrior
8/12/07

Q: Can I appeal after I undergo my treatment/surgery?

A: You can. However, it is about ten times harder to persuade the insurer to pay after the fact. Why is it harder?

You are “out of the store with the groceries.” The deed is done, the hospital and/or surgeon will start billing you. It’s difficult to deflect those bills once they start coming in. Much easier to get the insurer on board ahead of time

You have had your treatment, you are recuperating. This is not the optimum time to do battle with your insurance company.

You are receiving a bunch of bills that you shouldn’t have to pay ... very stressful for all concerned.

The reason why people ask me if they can appeal after their treatment/surgery is because the sugery date is drawing near. In many cases, they have had months to persuade the insurer to pay ... why has this gone on until the very last minute?

First, fear. The person is afraid to confront the health insurer, so they keep putting it off. “I am afraid that, if I confront them with all this, they will cut me off.” If you don’t confront them, they won’t pay. If you do confront them, and hit them with all you’ve got, they will pay, they will respect you, and they will be nice to you for a very, very long time. Which matters more, the sensibilities of your case manager, or your own life?

Second, denial. I don’t want to believe that my insurer would do this to me, that I really have cancer, that I really have to go through this treatment. If you are sick, and you have to fight your insurance company, truth is your sword and your shield. You win by facing the truth, by telling the truth, by insisting on the truth.

Third, the full weight of the insurance bureaucracy is trying to delay you. Delaying is an insurance company strategy. Delay = Deny. If they delay long enough, hopefully you will give up and go away. Your insurer will be so sweet, so nice, so concerned, so compassionate at delaying that you will be lulled into complacency until four days before your surgery. Then, you will call me.

Some real-life examples of health insurer Delaying Tactics:

  • We lost the letter.
  • We lost the fax.
  • We lost the email. (Who but an insurance company can lose an EMAIL?)
  • The person who decides that is on vacation.
  • Just wait for our letter. (It will be a useless form letter. Don’t wait for it.)
  • We don’t decide that until the day before the surgery. (Huh? I’m supposed to go into surgery not knowing if it is going to be paid for? I DON’T THINK SO.)

Waiting till after the surgery to fight your insurer? Just don’t do it.

Each insurer sets their own time limit on responding to appeals, but there is no time limit on issuing the initial denial. They will spend as long as you let them to make a determination on your case.

The minute you suspect that your insurer may not be interested in paying, you go into high gear. You write down every delaying tactic that they use ... you may need to quote them later in your appeal. You ignore all of the “we are doing our utmost”s, forge ahead, and get them buttoned up before your treatment.

When you have your health insurer so well organized that all they can say is, “Where do we send the checks,” you can go to your surgery or treatment in peace.