How to Handle Your Health Insurance Company

A number of people have asked, how was I able to get the health insurance company to cover my surgery. A surgery which they had previously deemed to be non-essential - that if I wanted them to even think about covering necessitated an additional 15 day approval process.

I'd like to say that the insurance company stepped up and did the right thing, except that of course they didn't. So here's what happened.

When my surgery was initially cancelled, my doctor's office dutifully submitted the additional paperwork detailing the necessity of the surgery. I called four days before my re-scheduled surgery, and the end of the 15 day period, only to be told by the insurance company "I'm sorry, we don't have the information from your doctor's office" and said some other b.s. how it's better to fax rather than mail (even though their form says either is just fine).

In a panic I called my doctor and they re-faxed the information. The next day I called the insurance company again, and I began to ask about the surgery being covered.

"I'm not sure if your paper work has been processed."
I sat in silence for a full ten seconds, and then said "OK, well the paper work was sent in well over 15 days ago, and let me just tell you this: I have nasal polyps and I'm in my last semester of law school. Now, if I don't get treatment, this can turn into meningitis or cancer -among other things- and can ultimately give me brain damage. I can assure you that if something happens to my brain that now contains over $100 grand in education, my loan companies will be more than happy to hold your insurance company liable. And my law school education is far more expensive than my measly day surgery."
There was a brief pause on the other end and then "Ok then, please hold while I check on that."

When the man came back 15 minutes later, magically, I was approved. "Someone was supposed to call your yesterday to let you know it was all approved," he said.

Sure. Especially since the day before they claimed they didn't even have my paperwork. And people say lawyers are bastards.

Breathing Optional

So at 3:00 p.m. my health insurance company informed my surgery center that they don't cover nasal surgery. For any sort of nasal surgery to be covered, I will have to pursue an additional 15 day procedure which will allow the insurance company to determine if my surgery is "medically necessary".


To my Student Health Insurance: This is all shit that could have been brought to my attention more than 12 hours prior to my surgery.


I basically have tumors in my nose that cause a chronic sinus infection, which could ultimately cause me to have a brain infection. I'm not sure what could be more "medically necessary" than this surgery.

There's also the small fact that oh I CANNOT BREATH OUT OF HALF OF MY NOSE. As I'm wheezing and bitching to the health insurance man he says "I can see that you are having some trouble breathing." But it's not clear if that fact will be sufficient to find that the surgery is medically necessary and therefore covered; the insurance company reviews these surgeries on a case by case basis. So if I understand correctly, my health insurance may consider free breathing "optional".

So I've had to cancel my surgery. But hey, if I have to have emergency surgery, *that* will covered. At which point my brain may be worthless.

Fuck you, health insurance.