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Harry Gross: An 'orphan' in claims storm

Dear Harry: We sure do need health-care reform! I have an "orphan disease" (one with very few victims). As a result, I am often running into problems with my insurance. There are no cures for what I have, but there are treatments that can make my life more free of constant pain and discomfort. Every time the doctors want to try a new treatment, I have been turned down and have had to appeal. I once had to subject my doctor to an interview by a claims official. Is there some way to get the insurance company, once and for all, to stop putting me through this process every time? I'm sick enough, and these toads make it worse by their persistent "no's."

What Harry says: This company is trying very hard to discourage you from getting what you're entitled to. Unfortunately, they probably have the right to question your treatment under the terms of your policy. You may be able to get the company to realize the severity of your disease by sending articles from professional journals in addition to what you have already given them. It may be difficult, but you should try to deal with the company's chief honcho of their claims department. Enlisting the Insurance Department's help (215-560-2630) may not solve the problem, but it is worth a try. I'm sure you get the feeling that the claims officers you have been dealing with are trained to deny any claim and force an appeal. It does appear that you will be helped by the newly proposed reforms. Good luck!

Write Harry Gross c/o the Daily News, 400 N. Broad St., Philadelphia, PA 19130. Harry urges all his readers to give blood - contact the American Red Cross at 800-GIVE LIFE.

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