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How I Beat Health Insurance!

Well, I didn’t really beat ‘em so much as I wore them down.


That’s legit, right?

We care about your mone....YOU! WE CARE ABOUT YOU!

That counts, right?

In this day and age when you’re almost always crossing your fingers anytime you open a health insurance ‘Explanation of Benefits,’ it’s nice to finally get a win when dealing with these pricks.

Sure, they make you sweat it out before you get to the golden goose of ‘we’re gonna cover it’ but it’s SOOOOO satisfying when you do.

Here’s the story.

I’ve been on an anti-depressant/anti-anxiety medication called Viibryd for at least 10 years. In normal, trouble-free life, I have anxiety issues so you can imagine how those issues were blown up when I lost my job last October, father in law died, and my Dad declining ever so steeper into Alzheimer’s.

Yeah. Not good.

About a few weeks ago I called the pharmacy to see what was the deal with my refill. They said it was going through Prior Authorization (‘PA’, for the cool kids in the medical world!)

Backing up a bit though, we had to go on my wife’s new job’s health insurance which means a whole new formulary and a whole new company to deal with.

Now back to where we were….

The insurance company that handles our medication, RX Benefits, denied the coverage.

My doctor’s office appealed on my behalf.

Denied again.

So I write them an appeal that essentially tries to appeal to their humanity by explaining all the reasons why I need this drug and the recent events that have made it even more necessary.

I finished the letter with declaration that if your humanity won’t work here maybe me contacting the local and industry regulators would.

Appeal granted! (*drops microphone!*)

I got the call and voicemail from my doctor’s office the other day and she, the front desk lady, said they had good news: looks like your appeal worked.

She even wanted me to call her back to see how I did it.

Below is how I did it.

The lesson here?

Fight. Fight ‘em to the end. They usually deny knowing that the majority of people will just roll over and take it. But if you have reasonable arguments and maybe even appeal to their better, more empathetic, angels, you too can get an insurance company to bend the knee.

And it that doesn’t work, threaten to report ‘em to the insurance regulators.

Now if you’ll excuse me….time to take my pill.

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