Why I Practice Consumer Law (Part I)

Why I Practice Consumer Law (Part I)

climbGenerally, life is an uphill battle.  Some things we encounter make life’s journey seem like climbing a vertical cliff.  We all have goals and we all face trials and tribulations that knock us down or lead us astray.  For my wife and I, our health insurance company’s and eventual debt collectors’ tactics almost derailed our dreams.  The only way we could deal with these entities and get back on track was to fight back, hard.  We learned to fight back and now it is what I do, professionally!

My wife needed an operation only a few surgeons in this country could perform.  We understood this surgery was going to pose many difficulties and uncertainties, from the risk, travel, pain, recovery, cost, and on and on.  We thought we could plan for these difficulties.  We talked about the risks and formulated adjustment plans.  We read our health insurance policies to familiarize ourselves with the terms “out of network,” “surgery,” “copayments,” “out of pocket expenses,” etc.  We phoned our insurance company, spoke with our eventual healthcare providers, and read as much as we could to build a surgery budget.

We followed our trusty health insurance company’s instructions and prepared for surgery.  My wife worked on recovery, we both returned to work, and we continued our budget to meet our upcoming payment obligations.  Surprisingly, what we perceived as the easiest to plan for, our portion of the surgery’s expense, turned out to be an absolute nightmare.

Just when things started to return to normal, we received our first “explanation of benefits” from our health insurance company.  The health insurance company denied approximately 70% of our medical bills.  As a result, the healthcare providers billed us and almost immediately turned us over to debt collectors.  Essentially, we were now expected to pay about 14 times the amount we budgeted, and fast.  Our insurance company took every opportunity to explain how we were responsible for the unpaid bills because we did “this” wrong or “that” wrong prior to the surgery.  Interestingly, the precise reason for calling them was to figure out what we needed to do, not to chat about the most recent football game.

We experienced firsthand the numbers game insurance companies play with their customers.  How these companies play this game really impacts consumers.  The impact on our lives was significant.  We discussed no longer being able to reach our goals.  We talked about getting by without our car, putting our hobbies on hold, and started discussing the possibility of bankruptcy.  Many of our discussions led to arguments brought on by frustration.

In Part II, I will cover some strategies that helped us deal with our insurance company and health provider, and cover some that I wished we would have used.  To be continued…

Kay Lynn Lee