Using my powers for good

When I started writing about Suzette and Emily last month, I never dreamed that my efforts would nudge an insurance giant like United Healthcare to do the right thing.

I need to work on raising my expectations.

Indeed, Suzette recently emailed me with the wonderful news that UH finally paid the thrice-rejected claim for her daughter Emily’s Boston Brace, covering 60 percent of the cost ($1,369.23) – in-network benefits to an out-of-network provider due to “medical necessity.”

If you know anything about brace treatment for scoliosis in young adolescents, you know that Emily, as she grows, will need subsequent Boston Braces. However, Cindy, the UH rep who confirmed UH’s action on the family’s case, told Suzette to contact her directly if she has any problem with future claims.

Suzette credits the WPTF radio interview she and Emily did on Aug. 19, the result of a media pitch I made to the station’s news director, for reversing UH's previous decisions. After months of frustration, dealing with UH’s bureaucracy, Suzette wrote in her email to me: “My gut feeling is…(i)f not for the WPTF 680 AM radio interview, NOTHING would have prompted this company to ‘re-review’ this claim. NOTHING.”

If she’s right, I’m thrilled I could help, but Suzette deserves a large chunk of the credit. A fellow “mama bear,” she is one of the most tenacious individuals I’ve ever met. You only need to read (and believe) the quote at the end of her emails to understand why: “There comes a time when you have to decide whether to fish or cut bait.....And I take fishing to the EXTREME!!!!!”

Bottom line: if Suzette didn’t have a paper trail a mile long, documenting her relentless efforts to make a case for Emily’s doctor-prescribed brace treatment to UH, this story would have never sprouted the wings that it did.

It’s unfortunate that ANYONE needs to go to such lengths to be heard when they’re just trying to ensure quality health care for their family. That’s why Suzette and I have agreed to continue sharing her family’s story in the hope that other families may avoid what theirs has had to endure.