Filing a Humana appeal and grievance...

The best news of the week came in the mail on Monday! Maybe the best news of 2014 so far! Humana accepted our appeal for a little ER visit with zach.

I won't go into the long story..but on a Sunday back in September he suffered from a horribly painful episode of abdominal pain (which turned out to be constipation). After several OTC medications failed and lots of screaming ensued we decided to take him to the er. 

About 2 months later we get a nice bill for $500 and upon follow up with Humana, I realize there was another $1500 one on the way.  

Unfortunately when it comes to talking with Humana representatives I can't keep myself together no matter how many deep breaths I take. Just when I think "I can do this!", I totally lose it. And my last phone call ended with a click on the other end. I wouldn't have been so upset if:

1. I didn't owe $2000 dollars

2. They hadn't transferred me 3 times and I was on hold for 30 minutes

3. They hadn't lost all of my paperwork and claimed to have no knowledge of the fax number I sent the paperwork too. To make it worse I read the fax number off of humanas own website as I was on the phone with them! 

4. I'm imagining $600 per month disappearing from my paycheck only to be denied medical coverage. 

So I just gave up and told Kyle I could no longer deal with them from them on the phone. Thankfully I had already done all of the paper work and had saved a copy of everything. I just wasn't planning on ever calling them again! 

So, what to so when you are denied??  I went to the internet for help and found a great website with advice on how to file an appeal. 

http://www.patientadvocate.org/resources.php?p=36

Here's what I did...although hopefully I won't ever have to do this again.

1. I wrote a 2 page letter detailing everything that happened that day, why we went to the ER instead of the pediatrician (they were closed) and why we thought it was potentially a life-threatening condition

2. I got his pediatrician to write a letter, which actually ended up being just a statement saying he was a patient and had gone to the ER on that date. Even though I'm not sure it was very helpful, at least it showed that I was making an effort. 

3. I printed out medical info from a reputable medical website, which documented a serious life-threatening condition (obstructed bowel syndrome) that had the exact same symptoms that zach had that day. I highlighted those symptoms and was sure to note that we didn't know the cause of his pain. 

It was an ordeal but we were so relieved that they ruled in our favor!! I couldn't be happier!!  Now..as somebody at work teased me...what I am going to do with the $2000 I just earned? Nothing too fun I'm sure!!