Video: How to win a health insurance appeal

Larger screen

SEATTLE - New advancements in cancer treatment have led to better survival rates for patients.

But what if you can't get your insurance company to pay?

One woman fought the system, and she's showing others how.

"When people suddenly find themselves in insurance denial land, the first thing they usually do is panic," said Laurie Todd.

Todd should know. She may look healthy now, but in 2005 she had stage 4 appendix cancer. Her insurance refused to pay for the specialist she wanted.

KING

When her insurance company refused to pay for the specialist she wanted, former cancer patient Laurie Todd fought the system and won.

"I won my own appeal over three years ago," she said. "Nobody ever thought I'd be able to get them to pay, and then I went on to write and win another 34 appeals."

That's when Laurie became the insurance warrior.

Her advice? Get the denial in writing.

"On the phone, there's no accountability, nothing will change by calling on the phone except your blood pressure," she said.

She says not to take it personally.

"It's their job not to pay and it's your job to make them pay," Todd said.

Todd recommends including lots of documentation, including studies from the internet.

"If it's over $5,000 treatment people are asking for, that appeal should be at least 20 pages. Why? Because it intimidates by its very weight," she said.

Be sure to send copies to all the right people, including the insurance company's chief medical director.

Mark it urgent.

"I'm pretty tough," Todd said. "I say I'm not dishing out chicken soup for the soul; I'm giving them the weapons so they can win the battle and be alive to eat the darn soup."

Todd says the best weapon is if you can show that your proposal will cost your insurance company less, and she is proof the strategy works.

Laurie's 10-step plan to winning an appeal:

1. Push the insurer to deny your treatment in writing.

2. Write a full-fledged document.

3. Do your research.

4. Address your appeal to the right decision-maker.

5. Purge all emotion from your appeal.

6. Tell your own medical story, but don't tell all.

7. Disqualify all unqualified insurance doctors.

8. Supply precedent.

9. Conclude with the cost comparison.

10. Push the appeal along, and pester them every day.