“If you don’t have a backbone, grow one. If you have one, use it and use it often.”
That, that is the one tip, the tip, on how to advocate for yourself or loved one.
I know, it’s harsh. I’m sorry but…I’m not sorry. The lovely lady who I met in the early days of Kevin’s hospitalization wasn’t sorry either when she said this to me, and I’m glad. Reason being: a backbone is the key to making sure you’re getting the most out of every available resource. I’m not saying to be rude or mean, ‘thank you’ and smiles of gratitude go a long way. I’m not even saying to never ever take “no” for an answer. Sometimes, the answer is going to be “no.” What I am saying is to not take “no” for an answer until you are 100% certain that “no” is it.
Here’s an example.
(This going to be long, so if you would like to grab a cup of coffee I’ll wait.
This is the story about my recent difficulties getting the medical supplies we need for Kevin.
Since Kevin came home in July of 2016 we’ve been using Valor (not the supplier’s real name) for all of the medical supplies we need to keep his wound clean and healthy. K’s wound is big and requires a lot of bandages, saline spray, and other pieces. Every two weeks our wound nurse places our order for us and two-days later the supplies are delivered. Well, that’s what typically happens.
Three months ago we ran into our first problem with Valor, they sent the wrong bandages. At first, we thought is was a simple human mistake, especially when our wound nurse called to inquire and the person she spoke to gave no excuse or reason, she simply said sorry and immediately re-ordered the right bandages and had them shipped overnight to us. But then it happened again with the next order and the order after that. I was, to be honest, annoyed. Really annoyed. But because our wound nurse was able to quickly resolve things every time…I let it go. “One more time,”
Well, that “next time” came with the next order, of course. But the issue this time was not with the wrong bandages being sent, but no bandages at all! Nothing. No warning, no concerns at the time the order was placed, nothing.
Upset, I decided to call Valor myself this time. Admittedly, I should have intervened the second time the wrong bandages were sent. I didn’t because I didn’t want to make things difficult for our wound nurse since she has to work with Valor on a regular basis. “Let’s not make her already difficult job more difficult.” So, instead, I decided to stress myself out every couple of weeks, worrying if we were going to be able to stretch our supplies out long enough until the new order was (eventually) delivered instead of trying to solve the problem. # fail.
After a few…polite, yet stern comments to a supervisor at Valor, I managed to learn the root cause of all the issues we were having. The reason why the bandages were not sent, and why the wrong (cheaper) bandages were sent previously was because we reached our monthly limit with our insurance company. “Finally, an answer!” That excitement quickly turned into panic, “oh geez. Here we go. A fight with the insurance company.”
(FULL DISCLOSURE: I work for my insurance company. But even though I am an employee, I have to follow the same process and rules as a non-employee. I do not receive special treatment nor do I expect it.)
So, I called my insurance company to inquire about what was going on. The rep I was working with did a bit of research for me and found that there is, in fact a limit to the number of bandages we are eligible for per month. However, there was some good news as a result of this conversation—I was told that I could request an authorization for additional bandages based on the fact that the bandages are medically necessary for K. So, that’s exactly what I did with the help of K’s PCP and plastic surgeon. This process did take a bit of time, as a process that includes multiple busy parties does, but we got an authorization!
Problem solved? Yes!
On to the next one…oh yes, there was another issue.
Again, without warning, our first order for the month for December never showed up. Our wound nurse placed the order on a Monday and on the following Thursday we were calling to ask where the delivery was. Again, like the bandage issue, the first response was “I don’t know what happened” and an immediate overnight shipment was sent. The second time it happened, though, I was told that our insurance company had yet to respond to the initial authorization for the order. This seemed weird to me because at this point, we’ve been placing orders every two weeks for five months at this point. Skeptical, I called my insurance company and learned that…. there was no request from Valor pending with my insurance. Nothing!
Beyond frustrated, I called Sally at Valor—did I mention I had a direct number and name of a supervisor at Valor at this point? I explained that I spoke with my insurance company and was told that there were no authorization requests pending, none. “What’s the hold up?” Despite my information, Sally, without further investigation, continued to tell me the issue was insurance related and that it was out of Valor’s hands.
I called my insurance company again and confirmed that there were no authorizations pending. I then called Sally at Valor back, but this time, I conferenced in a supervisor from my insurance company. The supervisor from my insurance company confirmed for Sally that nothing was pending and strongly asked why the order had yet to ship. Suddenly, Sally’s attitude changed and lo and behold, the next morning, I had the order in my hands. And an important note: I have not had to chase after another order since.
Why Valor stuck to the “it’s with insurance” stance until I brought in reinforcements, I don’t know. I would like to say maybe it was a system problem on their end, but given how fast Valor’s tune changed once I brought in my insurance rep, I’m not willing to give them the benefit of that doubt. Jumping back to the bandage issues, why did it take so many orders before they helped me understand the root cause? I don’t know. All I know for sure is that, unfortunately, customer experience is not a strong-point for many of these types of vendors. And considering that some people’s lives are dependent on some of the supplies they provide, well, it’s sad. This, this is why it is so important to have and use a backbone.
Let’s highlight what I hope you got from this example:
If you’re facing roadblocks like the one I faced with the limit on the bandages, inquire with your insurance and physicians on what you can do. In many cases, there are options.
The Insurance Company is not always the bad-guy
Yes, I do work for them, but I have to follow the same process as our other members and (and!) based on everything I have seen over the last few years, I truly believe I would be saying this if I didn’t work where I work. The fact of the matter is, when it comes to a situation like this, your insurance company is typically ready to help you as you are their member and they need to make sure you are satisfied.
First, I should have called Valor myself from the get-go. While I would never want to make things difficult for our wound nurse, not having the supplies K needed was far worse. Second, I could have let things go when Valor continued to tell me that the issue was with the insurance company. But with both places telling me it wasn’t them, I knew the best thing to do was to get everyone on the same page myself.
I am not a healthcare professional. I am not a doctor. I am not a nurse. I am not a social worker. I am simply sharing the information learned from my own experience. Your experience is going to be different.
By reading, and if you chose, utilizing any information, tips, etc. found on On Caring and Grief you are doing so at your own risk.
Opinions expressed here on On Caring and Grief are mine and mine alone.