An ‘insurance warrior’ fights to get pricey therapies covered

Her name is upheld from one unfortunate family to another like an amulet.

In phone conversations and online discuss rooms, she’s mentioned during moments when a righteous competence call on a enthusiast saint. A baby innate with a misshapen skull? “Call Laurie.” An impossibly costly cancer treatment? “Call Laurie.”

Laurie Todd isn’t a doctor, or a lawyer, or a sanatorium chaplain. She’s a 66-year-old former massage therapist. Most of a time, she sounds contented and efficient. But if someone tries to lift a nap over her eyes, her voice gets low and a small bit threatening. “Do we know what we do for a living?” she asks. “I’m famous as a Insurance Warrior.”

article continues after advertisement

The troops embellishment is apt. When a health word association refuses to compensate for a medical procedure, Todd goes to conflict on interest of a studious from her unit outward Seattle.

She researches a systematic justification behind a treatment. She parses a excellent imitation of word policies. She scours a internet for a home phone numbers of a company’s tip executives, and she coaches her clients on when to call and what to say. Her plan seems to be working: By her possess count, she has won 165 of a 169 cases she’s fought.

“I’m sitting here in my pajamas creation decision-makers who get $20 million a year do a right thing,” she said.

There are all sorts of reasons insurers competence repudiate coverage: They competence call a diagnosis experimental, or contend it’s not medically necessary, or insist that a internal alloy in their network do a work, rather than a detached expert.

Many health economists disagree that insurers are right to repudiate coverage of some procedures in sequence to revoke America’s astronomical health caring costs. But even they determine with Todd about one thing: a complement is so tough to navigate that a standard studious feels unable when confronting denials.

“Health word is completely byzantine,” pronounced George Loewenstein, an economist during Carnegie Mellon University. “Even word executives themselves … have difficulty creation clarity of a beast they’ve created.”

That’s where Todd comes in.

“I would be a widow if not for her,” pronounced Diana Lentz.

“I am a story person. This work puts me during a epicenter of a world’s best stories”

Laurie Todd, a Insurance Warrior

When Lentz’s husband, Matthew, was diagnosed with cancer, their word association would customarily compensate for his medicine if he went to a internal surgeon who had small knowledge with a procession he needed. The Lentzes wrote an interest themselves, perfectionist that Matthew be treated by a loyal expert. It was rejected. They enlisted Todd’s assistance with a second version. It, too, was rejected.

Only when Todd and a Lentzes gave speeches to a house room full of word executives and lawyers was a coverage approved.

Read a many renouned stories this hour

Todd can pronounce legalese and knows her proceed around statistics, yet she attributes her success to her master’s in 18th-century French literature. Her appeals can run 55 pages, and they interweave technical arguments with clear sum that make a patient’s story come alive.

“I wouldn’t win them if we took a authorised approach. we win them since we take a literary approach,” she said. “I am a story person.  This work puts me during the epicenter of a world’s best stories.”

Reversing a genocide sentence

Todd wrote poems as a child. She complicated French, and since she was good during languages, her superintendence advisor told her to turn a teacher. She did. She didn’t like it much.

So she changed from state to state, holding jobs here and there, as a record clerk for a mechanism manufacturer, as a secretary for companies that sole all from cookies to phones, word to medical devices. In California, she attempted her palm during genuine estate, yet it wasn’t her crater of tea.

Todd was operative as a massage therapist in Seattle when she fell ill in Oct 2004. First, she beheld a exhaustion: She started feeling dog sleepy even before she put her hands on a patient’s back.

Then she satisfied her swell was removing bigger.

“I would be a widow if not for her.”

Diana Lentz, mother of cancer patient

She went to a alloy who pronounced she was fine. But her symptoms kept removing worse, and in Mar 2005, she was diagnosed with late-stage ovarian cancer and rushed into surgery.

That diagnosis wasn’t right either. It incited out she had appendix cancer, and it had widespread into her abdominal cavity, formulating tumors so saturated that there was still copiousness left inside her after 15 pounds were scooped out during a puncture operation.

Her oncologist told her there was no treatment. She motionless to do her possess research.

“The initial place we went was PubMed, where all a systematic articles reside,” she said. “What we schooled was that there’s lots and lots of scholarship about appendix cancer. And we schooled that there was a certain surgeon in Washington, D.C., who stood conduct and shoulders above a rest.”

But her word association would not compensate for him to work since he was out-of-network. From an insurer’s perspective, constrictive with certain hospitals allows them to keep a cost for any use reasonable.

From Todd’s perspective, though, a word company’s preference seemed like a genocide sentence. She knew this surgery was as perplexing as defusing a bomb, and she’d seen investigate display that a surgeon customarily got a best outcomes after behaving a medicine during slightest 150 times.

She’d left to see a in-network surgeon her word association recommended, and she wasn’t impressed: “I said, ‘How many of these surgeries have we done?’ and he goes, ‘Six.’ And we said, ‘How are your patients doing?’ He said, ‘Don’t know, don’t follow ‘em.’ And we said, ‘Thank we really much, I’m out of here.’”

Todd went forward and requisitioned her medicine in D.C. But she was in a bind. She was self-employed, and she was too ill to work. She had roughly no money.

Even yet complications, her medicine could cost hundreds of thousands of dollars.

“I wasn’t going to die since my word association refused to pay,” she said. And so she set about essay an appeal.

“Where do we start with a plan game? You investigate your opponent,” she said.

She examination a word company’s whole website. She combined a upsurge draft of a organization, inventory a CEO, and a clamp presidents, and a house members. She went to a open library, sat on a floor, and examination all they had on word law. She reviewed each essay she could find on appendix cancer. Then she began to write.

“Treatments are denied with words,” she said. “And denials are overturned with words.”

She estimates that her whole hospital stay cost $347,000 — and her word association paid for all yet $9.

A soldier in purple flannel PJs

The medicine was like removing strike by a bus, Todd said. She was in a sanatorium for 43 days. When she came behind to Seattle, she couldn’t stand a stairs to her apartment.

“It’s like a tsunami had swept all away: who we was before, my work, my stamina. we had no suspicion what was going to occur next,” she said.

What happened successive was a phone call, out of a blue, from a male named Bob. He had appendix cancer, and he indispensable a same medicine she’d customarily had. His word association was refusing to compensate for it, not since it was out-of-network, yet since they pronounced a procession was experimental. He’d listened from an appendix cancer support organisation that Laurie had customarily won an appeal. Could she assistance him?

She had zero else to do. Using her interest as a template, she wrote a request for Bob. “He called me 3 days later, and he said, ‘Laurie, they are going to pay.’ And my fun was immense.”

Bob’s was a initial of 20 appeals she wrote that year, mostly sitting during home in her purple flannel pajamas. At first, her clients were all appendix cancer patients, referred to Todd by other families.

As she started toll adult wins, her certainty grew. In 2007, she wrote a how-to book and trafficked a republic to pronounce during Rotary Clubs and cancer conferences. Soon she was removing calls from other kinds of patients. She customarily took on a ones, she said, that had “a towering of science” behind them.

“He said, ‘Laurie, they are going to pay.’ And my fun was immense.”

Laurie Todd

By then, she was charging for her services and earning a vital essay appeals. Todd won’t speak about her fees, yet former clients customarily paid between $1,000 and $2,000.

“Best $2,000 we ever spent,” pronounced Lisa Frank of Anaheim, Calif.

Her daughter had a serious form of Tourette’s that resisted treatment. The tics came on with such assault that when she was 13, she fractured her possess hip. But a tics customarily kept coming, a consistent spasms preventing a bone from needlework behind together. The pain, Frank said, done her daughter suicidal.

The word association wouldn’t compensate for a initial deep-brain kick that some doctors recommended.

“Initially, Laurie came off kind of clinical. She’s not overly friendly,” pronounced Frank. But Todd won her over with a singular question: What do we consider “experimental” means? Frank gave her a definition. “No,” Todd said, “that’s not what initial means. It means whatever your word association wants it to mean.”

Frank became an coadjutor on a spot. She followed all Todd’s instructions — even when Todd told her they would wait until a week before her daughter’s medicine date to start operative on a appeal.

That is partial of Todd’s strategy. If we record an interest months in advance, it becomes customarily another raise of paper held in official purgatory. It’s shuffled from one table to another. The stakes are low.

Wait until you’re down to a wire, though, and your story has drama.

Finding a 14 tip targets

The initial thing Todd does is to find 14 executives — a series is during once impressive, and also fits good on a cover page — that she can aim with a appeal.

Some will be from a word company. Some will be from a patient’s employer, since many Americans have self-funded plans, that means that a employer is a one profitable for a medical treatment. Then she includes a few “outside eyes”: customarily members of a word company’s house of directors. She picks them carefully: “I’m not going to select heads of financial institutions, income men. we like presidents of universities, since they competence be a small some-more impartial.”

These will be a people who will accept a appeal. And a phone calls. And a follow-up phone calls.

When she sits down to write, Todd initial lays out a contribution of a illness, provident little. She wrote, for instance, about a debilitating tics that wracked Frank’s daughter, from satirical her mouth to losing control of her bowels.  She wrote of a amicable siege caused by Tourette’s. And of a 28 medication drugs that had been tried, many of that had absolute side effects yet supposing small help.

Todd afterwards picks detached a insurer’s reason for denying coverage. In a Frank case, she mocked it for regulating  “the decorous new word association word ‘Medical studies we have seen.’”

After scouring a investigate herself, she wrote, she believed a association “would be hard-pressed to furnish these puzzling medical studies that uncover that low mind kick is used to provide Tourette’s, yet is not suitable for Samantha’s ‘circumstances.’”

Todd also digs by studious support discuss bedrooms to find precedents: past cases in that a association has concluded to compensate for this procedure.

She likes to send her appeals to a word association on Sunday afternoons. The successive morning, she and her customer start in on what she calls “the phone attack.”

“I’m behind a scenes directing a whole thing,” pronounced Todd.

Frank couldn’t have asked for a improved general. The word association capitulated, covering her daughter’s mind kick and a successive courses of antibiotics and follow-up surgeries. The diagnosis was a success.

“I never suspicion my daughter would ever be means to finish school, to learn to drive, let alone to have a date,” pronounced Frank. “Now she has a part-time job, she’s a senior, she has a boyfriend, she’s a smashing guitar player.”

“You have a right to eccentric medical review, yet how good are we going to be during holding advantage of it if you’ve got cancer?”

Dustin Berger, attorney

Families like Frank’s could go to an profession for assistance crafting their appeal. But “it’s not a remunerative thing for attorneys to do,” pronounced David Trueman, a New York counsel who taught medical law during Columbia. “It doesn’t tumble within a normal proportions of health law. There aren’t a whole lot of us out there who do this.”

Patients can also direct an outmost examination of their case. They have a satisfactory shot during winning: In states that alphabetise such statistics, a third to a half of word companies’ denials get overturned by external, eccentric examination boards. But it’s tough to navigate that complement alone.

“You have a right to eccentric medical review, yet how good are we going to be during holding advantage of it if you’ve got cancer?” pronounced Dustin Berger, an profession in Wyoming who has created about health word appeals.

Every health complement rations caring one proceed or another. And some competence contend that a soldier like Todd is sucking a complement dry. To her, that research is backwards: She believes she gets patients a treatments that have a best possibility of working, instead of wasting their time — and a insurers’ income — on unconstrained rounds of reduction effective interventions.

“People say, ‘The word companies competence come and flame your car,’” pronounced Todd, laughing. “But I’m a word company’s best friend. I’m saving them hundreds of thousands of dollars by anticipating a studious a best diagnosis for them.”

Many of Todd’s clients — she calls them “helpees” — have turn friends, and they send a solid tide of other patients her way. Now, they are enlivening her to sight a successor.

“She’s an comparison lady,” pronounced Frank. “She’s in her 60s, operative alone, and she’s not going to be around forever.”

About admin