How to Navigate the Health Insurance Appeals Process “Patient-to-Patient” Guide

I am humbled and extremely proud to have parted with National Nonprofit SPINALpedia. I’ve spent the last year writing a detailed guide to helping people navigate the health insurance appeals process with tips and tricks.

Navigating the health insurance approval and denial process can be a winding road filled with roadblocks at every turn, but if you understand where these barriers are placed you can divert around them in order to get to your destination. This will be a living guide and will consistently be added to over time by myself and many others around the country.

This guide is a culmination of my work over the last 10 years after being repeatedly denied medically necessary equipment I needed to not only survive in life, but to thrive. I have fought long and hard battles for equipment such as total hospital electrical beds, shower chairs, seat elevators for power wheelchairs, functional electrical stimulation bikes, pressure relieving mattresses, and more with much success.

My sincere wishes that people do not have to fight as hard as I have had to and please let this guide help you avoid some of the major mistakes I made along the way, and how I navigated multiple approvals with my health insurance company.

https://spinalpedia.com/health-insurance-appeals-process

MS. WHEELCHAIR AMERICA 2023 – HERE I COME!

It’s hard to believe that nearly 10 months have passed since being crowned Ms. Wheelchair North Carolina 2022.  I have been engaging in so many advocacy activities over the last year to further my advocacy mission. 

I am just a week away from heading out to Ms. Wheelchair America 2023 to compete with 22 other amazing wheelchair advocates in a competition that is going to create memories for a lifetime.

I looked up some of my amazing competitors, some of whom are actually friends of mine, and they all have fantastic platforms engaging in meaningful work to make our society more inclusive to folks with disabilities.  It certainly going to be stiff competition for sure.

I know people who lose competitions probably say this all the time, but honestly, WIN or LOSE I am certain of one thing.  All of the advocacy work I engage in around the country and globally involve collaborating with people.  I don’t just mean anyone, but rock-star disability advocates in their own respective fields regardless of what disability they may have.

So, I KNOW THIS FOR SURE — I will be collaborating and partnering with many of these rock-star women for years to come on so many different missions in the name of making the world we live in more inclusive for future generations.  I commend those that came before me and it is only fair that I do my part for those who will take over in the decades to come.

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A CRUSHING DEFEAT – BLUE CROSS AND BLUE SHIELD – CREATING A RIPPLE EFFECT

You work so hard for so long on a specific project only to have it practically blow up in your face.  I’ve been working with Blue Cross and Blue Shield policy directors for the last six months and I recently received beautiful “BS” letter as they say stating that my efforts to have adaptive exercise equipment reviewed under medical necessity was not going to be an option.

I have tried to play nice, it did not work, and that’s okay.  I’ve simultaneously been working on legislation on multiple fronts to be introduced over the next few months and few years from different angles.  I always try the path of least resistance first, this does not always work out, but it does not deter me either.

If you’ve been following my health insurance battles you will want to take a close read of this one because my entire disability advocacy career started out with health insurance equity.  It is naturally a passion project near and dear to my heart and one which I will continue to fight for on so many fronts.  What will ultimately end up happening is having to create a coalition of seriously smart lawyers, doctors, advocates, etc. in years to come.  This mission is going to be measured in many years, not months.

Fortunately, my spinal cord injury has taught me the definition of extreme patience.  For this I am thankful!

I may Sisyphus rolling the boulder up the mountain only for it to come crashing down on me.  However, I will start rolling the boulder back up the mountain in real time!  I will break the cycle eventually in the name of HEALTH EQUITY, and not just Health Equality.

Check out the Article on Push Living Magazine:

A CRUSHING DEFEAT – BLUE CROSS AND BLUE SHIELD – CREATING A RIPPLE EFFECT

CBS Live Interview – Healthcare Policy Change

I am truly beyond humbled and incredibly honored that CBC17 News crew in Raleigh came out to my home to do a story on Ms. Wheelchair North Carolina 2022 and the efforts many of us are making in trying to reform healthcare policy within the insurance system.

“Self Advocacy” is the single driving mission I have in my life to help others with disabilities not only survive in their life, but thrive through aiding them in getting the medically necessary equipment and services they need in their own lives!

This will always be a long-term advocacy project of mine and I will not stop until we see systemic change, but in the meantime, we need to navigate the broken system we presented with, which takes a village of disability advocates standing up for the masses!

Without Further Ado:

ABC 11 – News Story – Ms. Wheelchair NC 2022

I’m so honored and extremely grateful for a shout out from the team, especially Diane Wilson, at abc11 News on the healthcare advocacy work I am working on in the community and my Ms. Wheelchair North Carolina 2022 title this past weekend !

https://abc11.com/ms-wheelchair-nc-2022-raleigh/11243052/

Be Your Own Advocate & Fight For Your Life

It was such an honor to be a guest on Karen Roy’s Life Possible with a Disability Podcast. Karen Roy is a good friend and fellow Disability Advocate in the community. We talked on a range of subjects from love, life, adversity, and fighting for medically necessary equipment in the health insurance world, and what that entails.

Karen is a rock star in her own right who has been pushing for equal access to exercise equipment for those with disabilities, is Ms. former Wheelchair America, and now works with a large Durable Medical Equipment Company to push the boundaries for patient access in the health insurance world.

We had a great conversation and I do hope many people are able to take a lesson out of what we talked about in the podcast:

Playing The Insurance Game — 4 Secrets to Attaining Medically Necessary Equipment

It’s not a very well-kept secret that the insurance industry can be unjust in addressing the needs of many of us with disabilities—especially when it comes to attaining the medically necessary equipment and services we need to improve our quality of life and independence. While countless folks in the disability community are frivolously working to change the system, the reality is that we need to learn to advocate for ourselves within the current broken system. It’s not impossible. But it does require a bit of ingenuity, persistence, and sheer determination.

I was injured in a shallow water diving accident in 2010 leaving me a C6 quadriplegic. I was left to fend for myself with respect to fighting for the equipment I needed for my daily survival in my home. While I have an army of medical professionals in my Rolodex, many of them are overwhelmed by the number of requests to write medical necessity letters to insurance companies. As a result, I discovered early that I was going to have to learn how to become my own self-advocate.

Read The Rest on New Leaf Home Medical

https://newleafhomemedical.com/knowledge-center-articles/playing-the-insurance-game-4-secrets-to-attaining-medically-necessary-equipment/

The Never Ending Health Insurance Battle – A Year Later!

If you’ve ever applied to college you’ll likely remember waiting anxiously by the mailbox for that large envelope, which was filled with hopes and dreams of your acceptance letter into the school of your choice.  The small envelope on the other hand, filled with dread and disappointment, meant that you were likely going to have to fall back on your Plan B School.

As the years roll by and you grow up that distant memory of the large envelope stays with you.  It certainly stayed with me.  Over the last several years after fighting health insurance battle after health insurance battle I quickly came to realize the large envelope in your mailbox was the one filled with despair, rejection, and disappointment.  I dread that big envelope in my mailbox that has Blue Cross and Blue Shield labeled in the top right corner.

Over the past several months I’ve been tirelessly working on two major insurance battles, which has taken my every waking moment to push forward on while simultaneously building up my disability advocacy career from every angle I could think of. Every day as I would roll down to the mailbox my throat would get a little bit tight, my blood pressure would start climbing, heart racing, and as I was watching whoever was helping me open the mailbox that day turn the key I waited in eager anticipation for either the small envelope or the large envelope.

he last two battles I’ve been fighting have been for the VitaGlide, an adapted physical exercise rowing machine, and a total hospital electrical bed.  Blue Cross and Blue Shield had initially rejected both requests.  The total hospital electrical bed was rejected on the grounds that it was not medically necessary and the VitaGlide on the grounds that it was a non-covered benefit.  I’ll explain the difference in a moment, but I’ll start out by saying when you are rejected on the basis of something not being medically necessary you have many more avenues to pursue for appeals than you do if you get rejected because an item is a non-covered benefit under your insurance plan.

Let me tell you my story … on PushLiving Magazine: https://pushliving.com/the-never-ending-health-insurance-battle-a-year-later/

Never, Never, Never Give up – Even When Health Insurance Denies You

It’s hard to believe that it’s only the middle of February and with the state of affairs in the world today I try very hard to focus my energy on affecting change in whatever capacity I am able to in order to bring a little bit of light into this world.  I’ve said this time and time again, but kindness, positivity, and perseverance go a long way in my book.

I would be a hypocrite if I didn’t attempt to put actions to my words.  So, I have made quick work of focusing on two new Blue Cross and Blue Shield cases, which I believe are so important for so many who are disabled. 

My overarching mission in these constant insurance battles is not to just simply win “stuff” from insurance companies, but rather to strategically attain medically necessary durable medical equipment that not only improves the quality of so many people’s lives, including my own, but our independence and dignity.

The challenge lies in that many of our health insurance policies are simply outdated and many of them do not factor in the special needs for those who are severely disabled.  With that said, it is my goal to create a host of documents with letters of medical necessity written, so patients can just hand them to their doctors and fill in the necessary personal information. 

I’m working to change the system from the inside out, but in the meantime many of us really need to learn how to operate and navigate within the broken system we are currently faced with.  It’s not easy and most people don’t have the time, energy, or know-how to get things accomplished.  Unfortunately, many people just take their insurance policy at its word and don’t test the system. 

Change does not come from blind compliance!

We have to push the boundaries because we are, the disabled community, a very much forgotten about segment of the population in the eyes of health insurance policies.

Read the rest on: Push Living Magazine — https://pushliving.com/never-never-never-give-up-even-when-health-insurance-denies-you/