When you or a family member is battling health problems, it may be exhausting to think about fighting the insurance company too. But it’s important to know how and what to ask of your insurer — for both your sanity and your wallet.
Jean Chatzky, author of “Women With Money” and TODAY financial editor, knows from experience. Her son Jake, now 25 and doing well, was diagnosed with a congenital heart defect at birth. He underwent surgery at three weeks old, at one year, in kindergarten and again last year.
“As a parent, dealing with a child with an illness means you’re in the healthcare system and you learn to fight the healthcare system really well,” Chatzky told “Morning Joe” co-host and Know Your Value founder Mika Brzezinski.
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The costs of medicines, surgeries and other procedures can add up very quickly, so it’s key for women to know how to approach their insurers and avoid unnecessary fees.
“You have to be ready to do battle when it’s you against a health insurer,” Chatzky told Brzezinski. “You have to be ready to put your case together…and fight, fight, fight, otherwise these charges just are not going to be paid for.”
Chatzky feels insurers often say “no” because they can, but you could get a “yes” if you ask. For her, the biggest fight happened when Chatzky changed jobs — and insurance plans — between Jake’s second and third surgeries. Her new plan was more rigid about allowable out-of-network costs, and the insurer wanted a different doctor to perform the next surgery. But because experts told her it’s beneficial to have the same doctor operate successively on a child’s heart, Chatzky was set on keeping the doctor from the first two surgeries.
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That meant Chatzky’s family was potentially facing a six-figure medical bill. So she got to work advocating for her son: She made tons of calls to the insurer, including to the office of the CEO, until she finally reached the medical director. She was told she’d need a letter from the local hospital where Jake was being treated, stating that Jake’s doctor who performed the first two surgeries was better equipped to do the third. That took some convincing, but Chatzky ultimately got the local hospital to write the letter and Jake underwent a successful third surgery with his doctor.
“It was a difficult process, and I really felt for parents who didn't have the sort of journalistic research skills — and unwillingness to take “no” for an answer — that I used every day in my job,” Chatzky said.
But even if this is new territory, you can still effectively advocate for yourself and make sure you aren’t being charged needlessly. Chatzky shared four tips for women who find themselves in a similar situation:
First, figure out what you need — and how to ask for it. Are you seeking a reduced bill, or an itemization of costs? Pre-approval of a procedure, or appeal of a denied claim? Set your end goal and get educated on terminology and approach, Chatzky said: “Hit the internet and start Googling around for various ways people have asked for what you're asking for."
Make the call and put everything in writing. Take “copious” notes during all conversations with health insurance representatives, she recommended. Keep track not only of what you talked about, but whom you spoke to: Get the name, direct phone number and email address of each person with whom you communicate. Ideally, you’ll be able to keep in touch with the same rep and cut down on the preamble with every call. “There is nothing more frustrating than having to explain the whole story again and again,” Chatzky said. "If you can get one person to talk to, that's a big win.”
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Consider hiring help if need be. “You can hire a patient advocate or medical billing advocate,” Chatzky pointed out, recommending people stick to seeking out members of a prominent national association like the Alliance of Professional Health Advocates.
Recognize that sometimes you’ll have to push back. This doesn’t mean being rude, Chatzky noted, saying “it's possible to stand your ground with a smile — and I think you typically get further that way.” But with bigger asks, chances are high that the first person you speak to will have only so much power to help. “And if you think you're there,” Chatzky said, “it's OK to ask if you can speak to someone who has the authority to reduce your bill, approve this charge, or solve whatever problem you're up against.”