A N   E N Q U I R E R   S P E C I A L   R E P O R T

Five ways to improve your odds



If you're fighting to get insurance coverage for yourself, a seriously ill child or another relative, you can take steps to improve your odds. Doctors, advocates and others offer this advice:

1. Don't give up. It's often tough to understand complex insurance policies or government programs, but keep at it. Didn't get a call back? Call again. Didn't like what you heard? Ask to talk to a supervisor. When dealing with claims adjusters or bureaucrats, be cordial but firm. It helps if you can win people over and convince them to want to help you - but if they aren't cooperative they should know you aren't going away.

2. Document everything. Write down the names of everyone you talk to, what was said and time of day. Keep copies of medical records. If you appeal a decision down the road or just need to present your case to a supervisor, good records will be invaluable.

3.Educate yourself. Study your insurance policies, network rules and other restrictions. Ask questions about anything you don't understand. Join a support group offered by a hospital, an Internet site or county and state agencies or others. They can help you understand the system. An added bonus: Others in similar situations can empathize and help ease your distress.

4. Find one strong advocate. Talk to your doctor's office. Staffers often will help you lobby for insurance, Medicaid or other coverage. They've been through these issues many times and can provide a wealth of advice. Support groups can help you write letters.

5. Appeal decisions you don't like. Often, insurance companies or state health-care programs will deny your claim or request the first time around, hoping that you will foot the bill yourself or give up. But if you pursue it, you can sometimes qualify for help on appeal. Find out what your appeal rights are, and consider taking your case to the next level. It can make the difference between getting help or going without.



Back to Extreme Choices
 
Multimedia
In Their Own Words
Three parents speak out on how their child's situation affects various aspects of their lives. Hear their stories in their own words.
(Requires Flash player)

Listen to these mothers' advice for other families:
Barb Steele
Debbie Martin
Melissa Hahn

Photo Galleries
A Photographer's Journal
Enquirer photographer Michael Keating tells the story of these families through his own words and photos.

The Hahn Family
Melissa and Randy Hahn are dealing with a daughter that has extensive brain damage, epilepsy and a seizure condition.

Your Choice
These situations are hypothetical, yet drawn from real experiences. What would you choose?

You are a physician, free to accept or refuse anyone as a patient. Do you treat someone who has a low-paying job that does not proved health insurance coverage?
You make the choice.

How much care should your critically ill newborn receive?

How do you pay when your insurance runs out?

You're a legislator. Where do you spend the money?

Did You Know?
Ohio hasn't increased its payments to doctors seeing Medicaid patients in three years, but nursing homes get automatic increases every year. It's state law. Nursing home costs increased 31 percent in five years to $2.2 billion, making it the health care program's single biggest expense in 2001.