Fighting the Insurance Company – Example of

After My Son Suffered a Traumatic Brain Injury, I Was Told Insurance Would Cover His Medical Bills. I Was Dead Wrong.

When RJ was discharged from the ICU after three weeks, he was transferred to a rehab facility. After he got there, they called me on the phone and said, “Your insurance company called and said RJ’s rehab benefits are up on Friday.”

I said, “No, no, no, no. That’s covered. I was told by my insurance company that this facility is covered for at least 60 days and possibly more. We have more time.”

But all I had was a voice on the phone. Without written proof, without the summary plan description, I couldn’t prove it. So when the rehab facility got another call from my insurance telling them these benefits had lapsed and I couldn’t prove otherwise, I went to the facility and I asked, “Where am I supposed to take him? He’s in a coma.” I remember a social worker telling me I could look into foster care.

Months passed, and I still couldn’t get the summary plan description. I kept calling my insurance company, and they’d be telling me my benefits, and I’d say, “You’re giving me information that you’re looking at. Give me, like, a screen grab of your computer screen.” But they wouldn’t do it. They kept telling me it was being “revised.”

I did some research, and I found out that under a law called ERISA—the Employee Retirement Income Security Act of 1974—I was entitled to the details of my insurance policy.

So I called an ERISA lawyer and told him the situation, and he said, “I can help you, but you’re going to have to give me a retainer of $30,000.”

Stephanie Peirolo
First told at a show by the Moth, the live storytelling group, at the Neptune Theatre in Seattle

Readers digest: https://www.rd.com/true-stories/survival/when-insurance-stops-paying/

Stephanie Peirolo is executive director of the board of the Health Care Rights Initiative, a nonprofit providing advocacy and navigation services for patients and caregivers. This story was excerpted from All These Wonders.