hi, i'm meghan

photographer @meghillphoto by trade, 

Appealing Insurance Claims with Kindness and Education

Appealing Insurance Claims with Kindness and Education

here's the deal: humana doesn't like to recognize my previously existing condition of Ehlers-Danlos Syndrome, and has not fufilled their end of the bargain in my insurance contract. Because of this, I am having to appeal and appeal and appeal every claim that they refuse to pay. Instead of getting upset and heated, I am trying a different approach: kindness and education. 

This is step one in what I know will be a LONG and tedious process. I guess I'm sharing in hopes that YOU may find solace that your not alone in the appeals, that insurance companies may actually treat the insured like humans, and that you can take my letter and write your own from it.

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To Whom It May Concern at Humana Healthcare, 

My name is Meghan Hill, and I am a 30 year old female who has been diagnosed with a condition called Ehlers-Danlos Syndromes. hEDS is a collection of hereditary syndromes affecting connective tissue. In EDS, a basic building block of the body- collagen- is improperly formed, causing problems throughout the body. Despite this fundamental defect in structure, people with EDS usually appear to be normal and healthy. Each Type of EDS has a large collection of symptoms which vary widely from mild to severely disabling, and is sometimes fatal. I was diagnosed with Ehlers-Danlos Syndromes Type 3 at The Mayo Clinic in Rochester, MN three and a half years ago. Since then, I have been trying to get adequate care for my symptoms without any help. 

EDS is multi systemic. The faulty collagen structure leads to fragile tissue and body-wide dysfunction. Possible symptoms include but are not limited to:

*Musculoskeletal System: Unstable joints, full and partial dislocations can cause sprains, tendionpathies, muscle tears, trapped and stretched nerves, and acute and chronic pain. 

  • Cardiac/Autonomic Nervous System (ANS): Problems regulating heart rate , rhythm, or blood pressure; lightheadedness, fainting upon standing. Symptoms may resemble anxiety. 

  • Digestive System: GERD, gastroparesis, IBS.

  • Central Nervous System: Headache, dysautonomia. Can be affected by instability in neck, skull/spine juncture. 

  • Other: fatigue, pain, sleep dysfunction, pelvic organ prolapse, hernias, fragile skin, slow healing, easy brushing, poor local anesthetic effect. sometimes blood vellsel or hollow organ rupture. 

EDS is highly under-recognized. hEDS is “ likely the most common, though the least recognized, heritable connective tissue disorder.” - Dr. Marco Castori

Experts estimate that EDS affects as many as 1 in 100 people- more common than multiple sclerosis and Down Syndrome. Most people with EDS suffer for decades before receiving the correct diagnosis. EDS may affect 1-5% of the general population and only 5% of the EDS cases are recognized, especially in the United States. ( Dr. Brad Tinkle). The most common form of EDS does not have a characteristic physical appearance, but the clinical picture is often easily recognized by those healthcare experts who are familiar with Ehlers-Danlos Syndromes. 

I would like to assume that the medical professionals at Humana may not be fully aware of what Ehlers-Danlos Syndromes are and how they effect people who have inherited the faulty collagen structure. I would also like to assume that Humana is well aware that I have been diagnosed with EDS before my plan started with them, making my Ehlers-Danlos Syndrome a pre existing condition. According to the Discrimination act, Humana is “ unable to discriminate on the basis of race, color, national orgin, age, DISABILITY or sex. Humana INC. and its subsidiaries do not exclude people or treat them differently because of race, color, national orgin, age, DISABILITY or sex.” I am so glad you are kind enough to send that gentle reminder every time I get billed for my hospital care for my genetic connective tissue syndrome, Ehlers-Danlos. 

Since I was hospitalized against my will at New York City Presbyterian, after being admitted to the emergency room for symptoms stated above in my description of Ehlers-Danlos Syndrome, and was determined to be hospitalized due to a “flare up” of my Ehlers-Danlos Syndromes, I was told that Humana would be happy to cover my care within the Psychiatric department of New York City Pres. The bill I am receiving tells me other-wise, and I would like to appeal this claim. 

Please recognize that I am taking measures to hire legal council and settle this claim with your  insurance company as discrimination and the un-insurance of care for pre-existing conditions. Please take the time to carefully study my doctors notes, my files, and the complexity of Ehlers-Danlos Syndrome and re examine your refusal to pay. 

I appreciate your time and the service you offer to so many, 

Meghan Hill 

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