PAX Centurion - March / April 2015

Page 44 • PAX CENTURION • March/April 2015 617-989-BPPA (2772) BPPA Retired Patrolmen’s Division News Directors of the Retired Patrolmen’s Division of the BPPA: John Murphy David Mackin Joe Vannelli Joe O’Malley Billy Flippin BPPA RETIRED PATROLMEN’S DIVISION MEMBERSHIP APPLICATION Date:_ ____________________________________________ Name:____________________________________________ Address:__________________________________________ City, State, Zip:_ ___________________________________ Home Phone:_ ____________________________________ Cell Phone:_ ______________________________________ Date of Appointment:______________________________ Date of Retirement:________________________________ Email:_ ___________________________________________ Annual Dues are $24.00. The year runs from March to March. Please mail this application and $24.00 annual dues to the: BPPA Retired Patrolmen’s Division 9-11 Shetland Street, Boston, MA 02119 Fighting an insurance claim denial can pay off D on’t take an insurer’s rejection as the final word on your medical claim. Appeals can have a surprising success rate if patients combine help from their doctors, some research, and persistence. Insurance companies often make the initial decision to deny a claim based on limited information. They rarely see a patient’s file for that first decision, said Jennifer Jaff, executive director of Advocacy for Patients with Chronic Illness Inc., a nonprofit. “When you provide them with additional clinical information . . . it may turn out to be a very easy decision for them,’’ she said. Learn as much as you can about the reason for a rejection. Get the policy language and any information the insurer used to make its decision. Patients are entitled to this, so persist. It’s also important to know the insurer’s appeal process. This should be laid out in the letter you receive telling you about the rejec- tion. Understand the deadlines. I’ve never seen an insurance company grant an extension,’’ Jaff said. Write a detailed argument, with records backing up your claims. Enlist your doctor’s help. If the insurer says it doesn’t have to pay because your condition existed before your coverage began, a doctor may be able to argue otherwise. The insurer may say the treatment isn’t medically necessary.Your doctor can illustrate how all alternatives were exhausted before you started receiving the treatment in question. Rely on more than a doctor’s statement. “Insurance companies do not assume everything a doctor says in a By Tom Murphy, Associated Press letter is 100 percent true and accurate,’’ Jaff said. “What they really want to see are the medical records.’’ Asking for a compassionate allowance can be another strategy. Some policies will make exceptions to cover something if it could be lifesaving. Keep your emotions out of the argument and give the insurer something new to consider. Avoid rehashing information the com- pany already has. “It’s a business decision; it’s not personal on the insurer’s side,’’ said Pat Jolley of the Patient Advocate Foundation, another nonprofit. Know the insurer’s appeal process. Some may offer a couple of rounds of internal reviews and provide a specialist to examine your claim. That means you can have an oncologist review your claim for cancer treatment. Keep detailed notes of your contact with the insurer. Send appeals by certified mail in case the insurer says you missed a deadline. Communicate in writing whenever possible. This keeps you from having multiple phone conversations with different insurance repre- sentatives who may provide different answers. And be persistent. You may have to go through a few rounds of appeals and then take your case to an external review that involves a third party. The process varies by state and insurer. Former BPD Patrolman Don Green’s 3 rd Reunion of All Retired Boston Police Officers Monday, May 4, 2015 • 11:00 am-2:00 pm at Florian Hall, 55 Hallet St., Dorchester $25.00 PAYMENT IN ADVANCE ONLY!!! ABSOLUTELY NO TICKETS WILL BE SOLD AT THE DOOR For Tickets, contact DON GREEN 617-755-5745 • dgreen@donaldgreen.com Don needs to have your check no later than Wednesday, April 29 th !