A Battle Won

January 6, 2024

We will take the wins where we can right now.

In August, I posted about insurance denying a claim, a medically necessary treatment. A peer-to-peer review took place and did not change anything. We filed an appeal with the insurance company and their denial was upheld.

We rallied.

We initiated an external appeal with the state. A final step with no options available to us if this last resort reviewer upheld the company’s decision.

Some amazing professionals wrote letters of support.

I learned so much and gathered all the documentation I could.

Possibly a hundred hours put in. Plus a lot of feelings and tears. We know we are privileged to have the resources and support to do this. And our heart hurts for those that don’t. Everyone should have equitable access to the care they need.

We have been trying to settle with the worst case scenario but trying to remain hopeful as over a month has passed.

And today we checked the mail and found this gem. “The reviewer has decided to overturn the health plan’s decision.”

It’s validating. And we are breathing a little easier tonight.

It should not be this hard for anyone to get care. And we have another appeal process we may have to go through soon. But we are grateful for this outcome today.