This is an incredibly long story, but as I sit waiting in my hospital bed, I think it’s time to tell it best I can. I’m a bit whacked out on painkillers, so please excuse any errors, but here’s how working in insurance advocacy may end up killing me.
Six years ago, I began working for a small company that does health insurance advocacy. They get hired by enormous and tiny companies alike to act as a third party assistance with claims and benefits. They bill themselves as improving healthcare, and talk a big game about how everyone deserves equal access to healthcare.
Right before I was hired, I got a gastric band (Lap band). 9 months after I got the band, a report was published saying it does not work and fails often for people at my high weight. I have gained 60 pounds with the band despite following all the rules. I need a malabsorptive element (like a bypass or duodenal switch) to override my body’s insane tendency to store every damned ounce of fat I eat.
I started the process of getting the revision – insurance told me it was covered. Followed all the pre-requisites. Found the medical policy used by my plan – I met the criteria. Right before the surgery was to be scheduled (June 2021), I was told that my company actually EXCLUDES revision except under some very specific circumstances. See, they went from “fully funded” (insurance company makes all the rules and pays all the claims) to “self funded” (a cost saving measure where they can limit coverage but pay claims themselves).
I appealed twice, and both appeals were denied, with the doctor on the appeal board stating that while revision is medically necessary, they cannot approve it because I do not meet my company’s pared-down criteria.
Scared, unable to wipe my own ass, and constantly nauseous, I reached out to the CEO. It’s a tactic our own clients use to have their self-funded companies give exceptions so they can have necessary procedures their company saw fit to exclude.
It’s been weeks since I started that, begging the CEO to not let me decline further. They sent me to see one of their own doctors under their business umbrella, and that doctor agreed the revision was the best choice medically.
Meanwhile, my complications with the lap band worsened to the point I’ve been admitted to the hospital. Im trying for charity care since I still have gotten nothing useful from the company as the next person on their management “reviews” my case. My surgeon won’t do anything until he knows it’s being paid for. Hilariously, I’m running up a hell of a bill being inpatient, which makes me realize it’s not about the money – they’d pay much less if they just let me have the surgery.
So here I am, lying doped up in a hospital bed, afraid i may have very little future left at 34, and still sitting in limbo unable to get the treatment I need… and I work for a healthcare company. FML. And F the greedy oligarchs who got me here.