Meanwhile, in Houston, I met the invaluable member of MD Anderson's Proton Therapy Center administration who crafted my first appeal to Anthem. Trained and experienced in nursing, Ms. H has spent the past several years specializing in "denials management," and enjoys a 60% success rate. When I read her appeal, I could not fathom how Anthem would reject it--and I quoted it in the appeal that eventually won. In addition to writing appeal letters, Ms. H spends a lot of time on the phone with insurance companies. Her medical credentials allow her to talk with the nurses and doctors protected from the public by customer service. These professional links are often crucial for the success of an appeal.
Patients facing insurance rejections are usually alone, and this is terribly costly on a personal level. Some, like UC Davis employees, have an advocate hired by their employer. Patients recommended for proton therapy at MD Anderson have Ms. H, but no other center within MD Anderson has such specialists. Most of us choosing to fight insurance denials have to draw from our own resources in a time when our attention should really be going toward other activities, like healing, packing up and moving to the treatment location, and getting in touch with friends and family for support. If our society can find a way to "trim the fat" that results in battles between insurance companies and the people they claim to serve, then the patients will do a better job "building our muscles" for the more important battles we fight against our diseases. Meanwhile, people like Ms. H, who have both medical training and a passion for getting patients the best treatment, can use their professional links to identify and access treatment options rather than wade through paperwork.