Getting your health insurance company to accept your claim -


Getting your health insurance company to accept your claim

One look at Keith Skates and you would think he had it all - a nice home, a happy family. But life recently threw him a serious curve ball.

Skates says, "At that point [they] dropped a bomb - [they] said you have a very rare form of appendix cancer. That is a one in a million type of cancer."

A rare cancer that needed a rare surgery and the right surgeon.

"To take the tumors out [they] flood [the] abdomen with a chemotherapy bath. There is no one in Alabama who has done enough of these for us to have gone to," Skates said.

When Keith found a doctor in Washington D.C. who specialized in the treatment he needed, his insurance company wouldn't cover the out-of-network cost.

"Five of them had nothing to do with the type of cancer I had, never done anything with it. The other four did deal with abdominal cancer, but only one had ever done the type of surgery that needed to be done. It was on a very minor case. He'd only ever done one," says Skates.

Keith couldn't leave his life in the hands of someone who had little to no experience with his disease.

Skates says, "That was really the motivation, knowing kids depend on you. You got to get better."

So he called the "Insurance Warrior." Laurie Johnson Todd has spent the past eight years helping patients in similar situations. Her passion for this line of work comes from her own experiences.

Todd says, "The first appeal I ever won was my own lifesaving treatment back in 2005. I was diagnosed with stage four cancer. I was told there was no treatment for my disease and even if there were, they wouldn't pay for it. So I found the world's expert on my advanced cancer and then I fought my doctors and my insurance company to get them to pay for it."

Laurie takes on only a handful of cases, so she wrote a book that empowers the customer in a process where only the policy holder has control.

"Really, the patient, you're the only one who holds control with them and you're the one who can hold their feet to the fire in terms of getting the effective treatment to the disease, you're the only one," Skates say. 

In her book, Laurie details the steps to take to appeal an insurance company's denial. She helped Keith with his.

Skates says, "Basically what you do is present a story to the insurance company explaining why you should be covered, why you should use this particular doctor and why the other doctors they recommend would not be a proper way to go."

Laurie has personally helped more than 100 people fight and win their insurance appeals. Thanks to her help, Keith was number 103. He still remembers what it was like to hear his insurance company call to accept his claim.

Skates says, "You've made a very good case why you should go in that direction. I think you should go that direction. It certainly appears this is the person to do that. You go get well. The insurance will be taken care of. Don't worry about that you just go get well. That was an emotional day."

Now that he knows what it took to get the treatment he needed, Keith is happy to share the knowledge.

Skates says, "Don't take 'no' for an answer, don't take 'we'll call you back' for an answer, don't let them send you to voicemail, there's somebody who can help you. If you do go to voicemail, call back every two hours until you get someone."

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