Dear Insurance Company
Dear Insurance Company,
I read the letter that came last night. I saw the six single-spaced pages of documentation that was clearly written by a lawyer with my daughter’s name automatically inserted into the form. I can see the word “denied” at least four times in the first few paragraphs. I understand what you are saying.
I spoke to the people on your end. I know that the woman who answered the phone is just doing her job. I appreciated that when I told her I was a single mom who couldn’t pay (many) tens of thousands of dollars out-of-pocket, she put me on hold to try and find an alternate solution. I love that she was kind. But she did not even remotely solve my problem.
You see, my daughter needs this medicine. She needs it because otherwise we’ll go have to keep going back to hospitals to see different doctors and specialists. I do not do well in hospitals. Worse, our closest hospital is the one where I fell to the ground, a little over two years ago, and wept on the floor of the emergency room when I knew – really knew – that my husband was going to die. So when I have to go back to that hospital, or really any hospital, all I see is that corner room where my husband laid on a cot, drugged by morphine.
She needs this medicine, because she’s going into middle school, and I am already worried about a thousand other things. What will happen when she’s pulled from the safety of an elementary school where everyone knows our family and is thoughtful about how to talk to my child about our story, and is thrown into a school where kids might not be so kind? I know there will be unhappy moments in middle school. Why must she also deal with a medical issue? Especially if there’s a drug that might be able to relieve many of the symptoms caused by her allergies.
She needs this medicine because – dammit – haven’t we been through enough? I’ve already had to figure out how to navigate the health insurance system. I’ve already become a single mom who is totally in charge of three kids. I’ve already had to pay bills for Shawn months after his death. Isn’t that enough for one person? Isn’t that enough for one family?
I know the medicine is expensive. But I just googled your CEO and last year he made twenty million dollars. One man. In one year. I mean, I’m not going to say the health care system is totally and utterly broken in America, but….maybe he could put aside some pocket change and cover this medicine for a 10-year-old girl with an infectious laugh and a great smile? My daughter just has to take it for a few months, and then it’s done. I did the math and it would be only 0.15% of his salary for one year. He wouldn’t even miss it!
Listen, I’ve been on the phone with your representative for over an hour at this point. I’ve written most of this letter while I’ve been on hold. The representative says your insurance company doesn’t have the right paperwork. She says they never got it from the doctor, even though I know that the doctor sent it, as I have a copy. “Maybe it was lost?” the representative says in a hopeful voice.
Maybe your company has this paperwork and maybe you don’t, but something makes me think that the doctor – the one who teared up when she heard our family’s story, the one who said, “I’m going to help you” directly to my daughter, the one who has devoted her life to children and their health – something makes me think that it’s not her fault that you are denying us. I don’t know how much my child’s doctor makes, but I know it’s not twenty million dollars.
So, really, is it too much to ask you to cover this medicine? I know we haven’t spoken before. I know you don’t know me, because until recently I was on my husband’s insurance and he dealt with these sorts of problems. But he’s gone forever from this earth, and now it’s just me taking this call.
I’ve called you twice today and now I’ve filed a complaint. I’m working with my daughter’s doctor to resubmit all the things that were already submitted two other times. I get that these things are complicated and that everything takes time.
But I’ve had it. I don’t make twenty million dollars each year because I teach high school and so far, the market hasn’t allowed for teachers – or doctors – to get paid like that. But doesn’t it make sense to cover this medicine for a kid who’s already been through so much? “I wish I could help you” says everyone, but hey, health insurance company, here’s a way you can help a family that’s already dealt with enough medical heartbreak for a lifetime.
I’m asking you one thing. Or maybe it’s that I’m demanding one thing:
Cover the medicine, dammit.
Image Credit: Stefanie Harrington Photography.
Oh, how I’ve wanted to write my own variation of this letter a million times! Single mom, daughter with type 1 diabetes, and ever-increasing out-of-pocket costs related to keeping her alive. And I’m “lucky” because I have a great job, with supposedly “great” insurance. I’ve had the same conversations with her doctor, multiple insurance representatives, multiple medical companies. The system is broken, that’s for sure. I sympathize deeply with your frustration and worry. Best of luck in getting her medicine covered.
It’s so broken. And yes, the thing is – I AM LUCKY to have insurance and it’s still crazy! I hope things keep going okay with you and your daughter – that’s terrible.
Please join us in Canada, y’all. This posting just makes me mad.
For REAL. During his entire time living in the United States (over 13 years) Shawn never got over the insanity of the health care system. It’s nuts!
I worked in the dental/medical field for over twenty years and this insurance company’s excuse for not having the doctor’s twice-sent letter (“Maybe it was lost?”) is the equivalent of a kid saying “the dog ate my homework.” These companies are notorious for dragging their feet on claims. In one office where I worked, the office manager often spent hours on the phone with Blue Cross/Blue Shield in an attempt to pry loose insurance payments that already had been approved on patients. It’s maddening enough for a health professional to have to do that, but just unconscionable for a mother who’s trying to do her best to keep her child healthy.
I agree with Ian, above. Our country is woefully behind all the other developed nations. I thank God and Lyndon B. Johnson every day for Medicare. When my husband had radiation treatments to his head for his cancer, the fee was $89,000. With Medicare, the bill was $0. No one should have to go bankrupt because of health care costs.
I know – Claire’s doctor is saying the same thing. We’ve filed yet another appeal. It’s such a stupid process.
Ugh. So many layers of badness here, one of which is these companies know they are dealing with people who are stressed and vulnerable, and they use that to stack the system against us. Our healthcare system is so messed up that my employer provides insurance but also hires a 3rd party advocacy service to fight these battles with the insurance providers. In our last run-in, we eventually learned that the prescription benefits provider did not reject the drug prescribed. Little rejected the prescribed amount. We needed 60 days. The insurance would cover only 90 days’ worth. This… doesn’t make any sense.
My hope is that your appeal goes through. And don’t be afraid to name names. Public shaming is now an integral part of our wonderful healthcare system, too.
P.S. If my son’s 6th grade experience is any indication, Claire’s first year of middle school will rule.
I actually thought about tagging my health insurance provider on Twitter, but I worried about potential negative repercussions. But I will, if this keeps going! Thanks for the encouragement.
It’s shameful that insurance companies get away with this kind of thing. (You can bet if it was the CEO’s child this wouldn’t be happening!)
Beyond frustrating. We should not have to make multiple copies of forms so that IF they “lose them” we can send another!
My heart goes out to you and your daughter.
Thank you. And yes, it IS shameful!
That’s a great letter you wrote to the insurance company! You are also so right about the CEO and his 20 million salary.
Today I delivered a 5 page letter to the hospital ER’s business office with an application for financial assistance for my November visit to the ER for a kidney stone. I do not have insurance as we lived in South Africa 9-10 months every year. My husband was South African and was self-employed there. We did not have children together. He has 2 adult sons there and while I was away at a nursing home with my husband in the city, his children went into our house and took all the US Dollars we had for our trip here last year and told me it was theirs. I left with $2. that was still in the bottom of my handbag and ZAR70. (about $5.). So I really have to be careful about every penny and I certainly didn’t want to go to the ER, but the pain was so severe I knew something was wrong. I did not even let them do a CT scan because of the cost. My letter was similar to yours, just without a child in the picture! Now I must just wait to see what their verdict will be.
Ugh – this is awful. I’m so sorry you are dealing with all of this – my heart goes out to you!
Amen. Marjorie, I wonder if you feel that starting an online petition might be helpful? I may be barking up the wrong tree entirely, and you may already have thought of this. I’ve had some success in Canadian prison reform with such a petition and thought it was worth passing on the suggestion.
I hope to see you at the 5K again this year.
With every blessing for your daughter’s healing,
I’m still working on this issue….but maybe someday it will have to turn into a petition! We’ll be at the 5K for sure this year.
Call and ask for the qualifications of the person who denied the request. Usually they have no medical training but they don’t want you to know that. This either moves it up, the chain of command to someone who will actually read her chart or they approve rather than be called out. Good luck.
Yes, I’m still in the process of fighting them. It’s been a long one. But the next hour of my morning is devoted to it!