I am so thrilled that you have made your way to my “Patient-to-Patient” Guide on How to Navigate Health Insurance Appeal System!
My name is Ali Ingersoll and I am a C6 quadriplegic injured in a shallow water diving accident in 2010. I live an extremely rich and fulfilling life both professionally and in my disability advocacy (www.quirkyquad.com). A few years after I was injured, I started to understand how to navigate the world of spinal cord injury, medications, and health insurance denials – I was, to put it modestly, utterly overwhelmed with our current approval process within the health insurance industry.
It doesn’t matter whether you have Medicare, Medicaid or private health insurance, the system is needlessly complicated. So complex, in fact, that I moved to China several years after my accident for lifesaving spinal surgery because my health insurance company would not pay for the surgery.
After years of repeated denials for medically necessary equipment I needed to not only survive in life, but to thrive, I decided to take my healthcare into my own hands. I started to strategically learn how to make medical arguments to have the equipment I needed approved by my health insurance company by writing my own Letters of Medical Necessity (LOMN’s) backed up by peer-reviewed journal articles.
Many of us have each have our own challenging stories in life, but I quickly learned health insurance companies simply don’t care about what we go through on a daily basis. They only care about medical codes, diagnosis codes, strict definitions of medical necessity, among other formalities. With this in mind, I spent hundreds of hours researching why a specific piece of equipment I needed was medically necessary, how it reduced secondary complications within my life, and a few other very interesting tips that these health insurance companies do not like to announce publicly.
I soon came to realize that I was not the only one dealing health insurance issues as I started to partner with organizations around the country, helped individuals on their own cases, and started to take my work public.
In November 2022 I was crowned Ms. Wheelchair North Carolina 2022 on a health insurance advocacy platform. So many people reach out to me to help them on their individual cases that I started to think about how I could help more people. This leads me to where we are today. I have created a detailed step-by-step guide with numerous tips and tricks to help you make the strongest argument for whatever piece of equipment or prescription or service you are trying to have approved by your health insurance company.
It can be very daunting trying to figure out what you need for prior authorization, when you get denied, who you talk to, what medical professionals you work with, etc. I personally have a private health insurance provider, but the process is very similar for Medicare and Medicaid.
I welcome you to dive into my guide and if you learn anything along the way to make this even better, please don’t hesitate to reach out as this is a living document that will be updated over time! I do not want you to have to spend half of your day learning some of the very hard lessons I have learned, so if I can help even just one person become their own self advocate it is completely worth it!
My passion lies in coaching people with disabilities on how to improve their quality of life in order to live a life of independence, dignity, and grace. To do this we need certain pieces of equipment so that we might be able to live our best lives!