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Understanding, Accessing, and Appealing Your Benefits

Originally broadcast on March 22, 2000

Hello everyone. We're really happy that you're with us today. This is Faye Eldar from the University of Illinois School of Public Health. I'm the family coordinator for the Quality Community Managed Care Project, and today we're doing a program about understanding, accessing and appealing your health insurance benefits. Our speakers today are two people who are really knowledgeable in this field, and we're really happy that they've agreed to share their expertise with us. The first speaker will be Barbara Melman. Barbara is the owner of Claim Relief, a company in Chicago that specializes in helping people deal with health insurance claims, denials and appeals and she is also a columnist for the Chicago Sun Times. The second speaker will be Cheryl Carter. Cheryl is a parent of two children, a five-year-old son and a two-year-old daughter. She lives in a suburb of Chicago. Cheryl's daughter is profoundly deaf and she had a Cochlear implant last year, and she is going to share her experience as a consumer in accessing insurance appealing and dealing with denials in relation to services for her daughter.

Q. Barbara, could you tell us a little bit about Claim Relief, what you do and what your area of expertise is?

A. What we do is we literally lift the problem of people having to deal with their medical insurance issues We take over the handling of this. Through the column, I also am constantly answering letters and questions from people that are having terrible problems in dealing withinsurance and denials. I've been doing Claim Relief, for 16 years and I've had the column for four years. So I think I've seen just about every kind of problem that anyone could ever have.

A. When they first get the plan, they have to go over the information given to them, whether it's a booklet or however it's given to them. If they have a special issue or a special need for themselves or someone in their family, they need to write any questions and get right back to the company to find out exactly what it is in their situation they may need to know.

Q. Sheryl, would you say that before you had your daughter you had a good understanding of your health insurance benefits?

A. Let's say I thought that I did, but I did not. I was not one to sit down and read the book. The first time I really opened the book was just when we got it to make sureour doctors were in the plan. But I really did not know wha tI needed to know about the plan until my daughter was diagnosed. Then I read the book. I made copies of actually the what's covered and what's not covered and carried it around with me to different doctors and such so I could refer to it.

Q. And Barbara, what kind of written information should people get about the health plan and where can they get the information from?

A. Well they need to know what kind of certifications they need, what the customer service number is,keep their card handy all the tim and be aware of how the planworks. I think that's the most the first important thing todo is know what kind of a plan you have and then, of course,know what benefits are available under that plan. But you need to know if it's an HMO, a point of service, a PPO,exactly how does my plan work.

Q. Okay and people get a brochure from their insurance company or they get it from their employer about the insurance and they don't understand it, what do you recommend that they do?

A. Well, I recommend that they call. First I would try the customer service department of the company and hopefully. In many cases, you can get somebody who is knowledgeable of the plan that will tell you some of the basic concepts of the plan, again how it works, what they need to do in order to get their claims paid. Again, if you're looking at a certain provision in a plan that's iffy, it's going to be much more difficult than just finding out generally how your plan works. If you think something should be covered under the plan have it submitted and then take it from there. Don't make yourself sick over thinking something's not going to be paid. Make sure it's submitted and submitted correctly. Find out for the provider exactly what is needed to get that claim in for the specific item or treatment and then wait until it is process. Then, like I say, from there, start working on any reviews that are necessary.

Q. Okay. Now what about people who are in managed care plans where they typically don't have claim forms to fill out?

A. But you need referrals. And if you need a referral, and I stress this all the time to my clients and in the column, if you need a referral, keep copies yourself. Don't just trust that the primary care physician will send it on to the referring provider. You take control of that so that if necessary, you've got it in your hand if they tell you that that's one of the reasons that they are not paying the claims.

Q. Sheryl, what has been helpful to you in learning about what exactly the benefits were in the health plan and how you and your family were able to understand what the benefits were as related to your daughter's needs.

A. Well basically just by going through it. Unfortunately, we didn't really know of anyone who had been through this so really didn't know where to turn. So what we did is submitted our claim to the insurance company. They denied us. We read the book a little further, talked to the doctor, talked to the surgeon. And then asked for people we could get in touch with who have been maybe been through this, what they would suggest, different things that they had done and avenues they had taken to understand their insurance a little bit better. We also we called the insurance plan. We also called the person who manages the insurance plan who oversees the whole insurance plan and who can basically make the decisions of changing the insurance plan and wrote him letters as well.

Q. Could you tell us a little bit about the story about your daughter and how the decision was made for her to have the Cochlear implant? And if this was something you and your husband decided or a doctor in your health plan recommended this. Just fill us in a little bit on the background of you know from the beginning.

A. Okay. Well she was diagnosed for the first time at nine months old and the second opinion was at ten months old. At the suggestion of our doctor that we went for the second opinion. I was just a little bit happier there. The first time I was told my daughter will never hear. She will never speak like a normal person. She will never go to a normal school and I just felt that my whole world was falling apart and how do I handle this? And so I called up my pediatrician and said where do I go from here and he said give me a couple days. I'll find someone for you. We'll send you to five people if we need to. And that's when we found our second place that we went to which really just has a great team and they really have done a lot of directing for us. I put a lot of trust and confidence in them. What they recommended that we would do is put Skye in hearing aids for five months just to see if she would could get any kind of response out of her with hearing aids and make any progress that way. We followed her direction, did the home therapy and we could not get any kind of a response with Skye and hearing aids. Nothing. We would ring a cow bell behind her and nothing. Drop a pan, scream loud, truck horn, nothing would make this little girl turn her head or speak or anything. So we, at that point, were told by her therapist, if you want her to have a chance at spoken language and a chance to be main-streamed, we're not promising you anything, but this is the only avenue right now available to give you that chance. We figured what what do we have to lose? This is our only chance and we felt that we were really with a good team who had been directing us very well to that point. And so that was basically how we made our decision was that we had no other way to go. This was the only way to keep going forward.

Q. Did you have any problems with the insurance coverage related to this type of treatment?

A. Well, we did we did have problems with the insurance coverage even before we decided to go with the Cochlear Implant. Most insurance plans do not pay for hearing aids. So we understood that we didn't I don't believe we even tried to get them paid for because the hospital lent them to us. Maybe they knew somehow that we were going to go with the implant. I'm not sure but they just were very kind and lent them to us for the five months. But her therapy that we went to every week came out of our pocket and we tried sending in letters and submitting it to the insurance company and they would not pay for any type of therapy. They said it was like schooling and schooling should be paid by the parents. So to that point, and at that point, I wasn't ready to dive myself in I guess into all of this. I was more geared towards trying to find out about implants and what roads we were going on and what did we really want to do this and you know what I mean? There were a lot of different things that I guess I wanted to look into, so I didn't really spend a lot of time on appealing the therapy at that point. But when we did decide to go with the implants, we sent a letter of recommendation from our surgeon to the insurance and it was denied.

Q. What kind of insurance plan do you have?

A. We have it's called Preferred Plan, Inc. But ours is a little bit different than a lot of insurance companies out there I guess because it's a private insurance. So basically we don't, from what I understand, have really a lot that we can do even with even if we retained a lawyer because this is more of a private insurance. What it states in the book really is what they will do for you and nothing they don't need to do anything above and beyond.

Q. Okay and Cheryl this is insurance that you have through your employment?

A. Right, through my husband's employment.

Q. Do you have one insurance plan or two?

A. We have one insurance plan. They denied us for the implants immediately. It was probably a week later, I believe it said that an artificial ear is not an artificial limb and they only cover artificial limbs or prosthesis or arm, leg, something like that. I just I couldn't go for that. So we tried appealing. They came back and this time they said that it's not medically necessary. She could live a normal life without hearing which again I couldn't go for. So this is when I said okay we really have to try and get tough here, dive ourselves into it. So we contacted our surgeon again and asked her to write a letter. We had her audiologist write a letter. We had her therapist write a letter, the pediatrician, and a friend. We each wrote a letter, myself and my husband. I contacted the State Board of Insurance. I called state representatives. I wrote them letters.

Q. You did it all.

A. I did it all. I had an uncle who actually worked on a private insurance investigation practice. I had him look into it read the book, write a letter. I called the the doctor and I said do you have anyone who has been through this? Do you have any parents you can put me in touch with and I asked the therapists and other people the same thing. and I asked to be put on mailing lists and eventually through that I started to get contacts of people and what they had done. And so I saw some success stories out there and I said darn it, we can do this too. And unfortunately, we were denied for the third time, even after doing all of this. Advanced Bionics, which issues the device, had wrote them a letter. The woman had called the head of the insurance and offered to fly out. She had an hour conversation on the phone with him. The end of the conversation she told him do you know that I am profoundly deaf and I'm talking to you right now with an implant? And he got quiet and said I'm sorry. We still need to deny it. So we weren't sure how far we can push. So we decided to go after I said again a lot of praying and talking and deciding, we said one more time. One more time we're going to try and if that doesn't work, our backup is a fund raiser. We're just going to do a big fund raiser and that that's what will do it hopefully. And the fourth appeal was done by Advanced Bionics, the company again who issued her Cochlear implants. They wrote just a wonderful letter. I wrote another letter.

Q. What do you think they said differently that time than the other time?

A. I don't I know that they put something in there about the act for children with special needs. I know that there is some type of act. Barbara, you might be a little more familiar with that.

Q. Do you mean the Americans With Disabilities Act?

A. Yes. They put something about that in there and they called the insurance and asked if they wanted to discuss this a little further and the head of the insurance again he said well are they going to sue me? And she said I really don't think they want to take it this far and, of course, we didn't because again we were in fear for my husband's job. So they said how about we ask for another outside medical opinion So they had another outside doctor review it. He came back and said it was medically necessary. But the final decision was still with the company, even though this outside doctor said it was medically necessary. I think that really helped us. They said that they needed one more day. They told Advanced Bionics they needed one more day to just get their decision together. They had made their decision and, of course, I am just suffering that day thinking well, of course, it's no. If they have to think for a day, they have to write down all their reasons why they can't because they are thinking we may go ahead and pursue legal action. The next day, Advanced Bionics called me and the lady was screaming on the phone. This is the insurance coordinator and she says I have the the appeal in my hand and it is approved. She said that's right, this is the approval and I get goose bumps right now. I fell to my knees. I sobbed I thanked God I just I it just was so much emotion that i felt and it was a week before Christmas.

Q. Now how long did you actually fight the whole situation?

A. This was a four month process.

Q. Sheryl, you have done a phenomenal job. I can only imagine that you probably worked on this day and night for four months and did very little else.

A. I did.

Q. What recommendations would you have for other families regardless of what their child's need is but for having some needed service denied by the insurance? What advice would you give them?

A. I would first say to be persistent. If you get that denial letter, don't just file it away and say well they denied us. Appeal and if they deny you again, reappeal and then go through the avenues I did. Contact doctors the therapists that you might be going to. Ask them to get you on mailing lists and contact with other families. Keep asking them. There's a wealth of information on the internet and I actually found a support group on the internet that is an around the world support group for children with hearing impairments, but I am sure they have things like that for other special need children.

Q. You know I'm really glad that you brought that up because part of our Website where this broadcast is posted also is a resource list and we will be putting up information about this work that you're involved in and many resources for families who have children with all kinds of different special health care needs.

A. And it is very helpful to have that. I found this Website halfway into my appeal process and I really wish that I had found it much sooner than that because there are a lot of people who have been through the insurance ups and downs and just on a more personal level even outside of the insurance, just having somebody who's been through the same thing that you've been through. I would say definitely search the internet and with the search, it is so easy. You just type in this need and a lot of things will come up.

Q. Well I thank you for your advice and I think that would be really helpful to many families and parents out there. Barbara, can you tell us a little bit of people that you work with like what percent are involved with denials and what percent are other kinds of insurance problems?

A. Well of course it all depends on the diagnosis and I think that one of the things you want to do when you're dealing with a difficult situation like Cheryl's was is to not just deal with the person that answers the phone. But go above that person within the company and touch base with one manager if you can and stay with that person. Let them get to know you understand your situation. I think what Sheryl did was absolutely incredible and wonderful and hope just listening to you, Sheryl, was so wonderful to me because I see people going through these kind of things. And I feel like sometimes some days at the end of the day, all I have done is fight for people that have claims that should be processed and have not been.

Q. Barbara, something else that I just thought of. When you talk about going above the person who answers the telephone and finding a manager to work with, a lot of people report that every time they call the insurance company, there's a different person for them to talk to and when they ask if they could have just one person to call, they're told well no that's not possible. So could you go through some basic steps to find a contact person within the insurance company?

A. I think if it's just a regular claim situation that you want to know why something was paid the way it was or if there was a mistake, they're going to tell you that you just need to speak with whoever is on the line. But if it's a situation that you've already put in a review and the review was denied and you're putting in another review, you just have to let people know. It's kind of hard I know for just a person to try and call up and say I need to speak to a manager. But the only thing that I can tell you to do is just to just be persistent and I know it is difficult and I know it can be difficult, but my word is fight and be very nice but very firm.

Q. And is it best to have these conversations over the telephone or do people need to send letters or both?

A. I would say definitely both. And whatever you are having your provider send in for you, I would keep a file so that you do know everything that's going on and everything that's been submitted to the insurance companies. So when it's at the point where you're dealing with getting the job done, you know exactly what you're talking about. From the very beginning when you start working with an insurance company, document the date, time and person you're speaking with and just a little bit of what that conversation was about. And if you have someone's name, they can't tell you we don't have any record of that call. So you have to be the one to keep those records.

Q. So you think it might be a good idea for people to have a special notebook where they right in everything?

A. Definitely. Absolutely and like I say, put the date, the time, the person and just a little bit of what that conversation was about. And if you tell them that you need to speak to someone in particular because of the situation, I think, one time I I was arguing on the phone for like 15 minutes with a woman and and she was just just being just so bullheaded and she wouldn't listen to me and I knew she was wrong. And I just wouldn't let up on her. And finally she became so frustrated, she said well I'll pass you on to someone else. And I had said well I asked you to do that a long time ago. So you just have to stay in there because it's not easy. You're talking to people that are almost reading scripts.

Q. Let me ask you something else. In the health care field, we often hear that some insurance companies have a policy of denying every claim the first time it comes through. Is that true?

A. No. I've never really seen that. I've certainly seen claims denied on a daily basis that are incorrect. I have yet to take on a new client and take in a lot of work and batches of work and and go through everything and not find errors, but I think in general, most claims do go through correctly. There's always the few that do not, but every single claim does not get denied in general most of the time.

Q. Sheryl, did you find any errors in the the claims that were

related to your daughter's surgery?

A. I did.

Q. How did you find the errors?

A. Well fortunately, we, as I mentioned, were hooked up with a great therapist so I would bring her my copies of denials and again, like Barbara said, I have one of those books that has become a huge probably five inch binder now and I have everything sectioned off in date order and I would bring it to her and say this is what I got in this week. And she looked at the coding for therapy and she said this is the wrong coding. We need to resubmit under a different code. So I understand that there can be some problems with the coding.

Q. Okay Barbara, could you please explain to us what exactly this coding is?

A. Well, there are different kinds of codes. There are procedure codes which tell the insurance companies exactly what was done if it's surgery or an office visit or an extended visit or whatever it would be. And then there are diagnosis codes. And diagnosis codes must match the procedure codes or somebody won't pay for it.

Q. Okay and where do these codes come from?

A. Oh gosh there are well there's books. I don't have it in front of me so I can't give an exact answer but there are people that had that got together that did the coding it's like universal coding.

Q. Okay you're talking about the CPT codes?

A. Right CPT right.

Q. How would a consumer be able to know if the right codes are on their claim?

A. Well they won't and just like Cheryl said, it was by showing it to an expert in the field. People that work for these billing services they hopefully become billing experts. But just be aware that that could be one of the reasons that a claim is improperly paid or denied. And it isn't even just a matter of denial.

Q. It could be a word processing error just like somebody spelling your name wrong?

A. Absolutely right. These numbers get put

in incorrectly all the time. And so when you get a denial, it isn't always the insurance company's fault. Just like Sheryl said, sometimes many times it's the fault of the actual provider submitting the claim and then the insurance company will deny it because it's the wrong code.

Q. Okay. Now Cheryl, I know you've worked very very very hard for your daughter to have the surgery and treatment. Do you still check all of the claims and all of the have the therapist all the codes to make sure everything now is correct in addition?

A. Well I know the code now so I just match up the last one and make sure it is correct. But it took us sometime to get the coding correct.

Q. Are they paying for most of her therapy?

A. They pay for none of her therapy.

Q. None of her therapy?

A. None. I looked at it that we really fought on this. We got the insurance to pay for the surgery. They paid 90 percent of the surgery. Fortunately, the other ten percent was written off and it's between a 40 and 60 thousand dollar surgery. So at that point, I was thrilled for that. We did try appealing the insurance for the her auditory verbal therapy and for her meetings with the audiologist which occur approximately every four to six months as I mentioned earlier. So there is a lot that they still don't pay for. We have continued to appeal for them. I'm not letting down. I don't want to push them too hard. As I call it, I like to be pleasantly pushy and I feel that I have learned through all this how far I can push and I would like to maybe readdress it a little bit harder in maybe six months or so just to give them a little bit of time and I think I need to do a little bit more research. I've done a lot of research though and it looks as though we're not going to win this one unfortunately.

Q. What do other parents tell you?

A. I have well again my therapist who is very good with directing us, has only two on her caseload that the insurance does not pay for and I believe she has 18 or 20 on her caseload and there's only two that the insurance will not pay. I get on to the support group on the internet. A lot of people get their therapy paid for and a lot don't. But you don't know each person individually so you don't know how hard they are pushing and I know myself I have really tried with this. And being that it is a private insurance company, I don't know how much further we can go. Q. Barbara, perhaps you can also talk about insurance plans that not only is every in companies who write policies for health insurance. But also every employer makes their own contract with the insurance. So even if two people have the same health insurance plan and they have different employers, their benefits won't be the same. Can you tell us more about that?

A. Right, well there's self-insured plans and then there's plans that are issued through a state. And if a plan like Sheryl's is self-insured, then they, as she said, run the plan

themselves and can make the decisions. If a plan is issued through the state and it could be a large company. In that case, it would be the state that the plan is actually issued, not your own state. Then you have the Department of Insurance of every state to hopefully help back you up on some of these situations. And what you do is you gather up all your information as well and I would always first you do your reviews with the insurance company. And after you've been denied and you feel that you're just hitting a brick wall, you should gather all that information and send it to the Department of Insurance and they step in as an intermediary. And I have seen, it's kind of a mixed bag. I've seen people win and I've seen people lose. But they do make the insurance companies accountable for why they are denying claims.

A. We did write the State Board of Insurance also.

Q. And they said they couldn't help you right because it was a self-insured plan?

A. Well they said that they couldn't help us with the therapy. They did try and help us with the surgery itself and by the time they got back to us, we were right in the middle of the appeal process. I guess by the time actually they had gotten in touch with the insurance company, the insurance company had then done their approval. Maybe the insurance it could have been a combination why they approved us. It could have been because of the State Board of Insurance. The congressman that we had wrote. I asked them to call. I asked them to write letters. They sent me copies of letters.

A. I also always do tell people to contact their state reps and if necessary their U.S. reps to get answers on some of these questions. We elect these people. They're there for us. And I think we should be entitled to have them help us.

Q. And what about for people who are in labor unions Could you address that?

A. Well again, unions are writing their own plans. So it it's like if it's private industry writing the plan, you have to go to the through the union to try and get them to change the determination on the on the responses on the claims. Another thing I would just like to bring up again what we were speaking about and that was how to keep track of all of this. What I suggest and what I've always done at Claim Relief is to get a chart and make columns and do the provider, the date of service, the total bill, the insurance company, if there's more than one company and how much is out of pocket. And every time you get a copy of a bill, put that bill on your chart and the date of service. And once insurance pays, put how much they paid and how much is out of pocket and that can be your determining factor. If you have a limit on how much you have to pay your out-of-pocket, you can keep track of it that way too for deductible and co-insurance amounts.

Q. A note to our audience. We will have a chart like this on the resource section of the website that you will be able to download and print it out to use at home. Now you get lots and lots of paperwork from the insurance. How do you decide what you need to keep and for how long you have to keep it?

A. Well what I do is when I when I get the explanation of benefits, I attach it to the bill. And you could have four or five copies of one bill. And I only keep one that's itemized. And once it's processed and paid by insurance, I staple them together. Before they are completed, I clip them together. Once they are completed, I staple them and then I know that that's a closed bill in my file. So if things have a clip on them, they're still active. If stapled, they're done.

Q. And then how long do you need to keep all the the bills and the claims?

A. Well if it's a large claim and there's possibly something that could come back again on running kind of bills, I'm thinking chemotherapy and radiation therapy, those kind of things that can go on and on and on, I would keep them probably a couple of years just to be safe. And try and keep things in date order and again if you can refer back to your chart, that will help you very much in keeping track of all of this.

Q. What do you do if you lose a copy of a bill or a claim or an appeal?

A. Well I would try and call and get new copies.

Q. And who would you'd call the insurance company?

A. Sure but now sometimes insurance companies say we cannot send you another copy. You might want to check with the provider if they got a payment and if it wasn't a bulk payment where there was thousands of dollars for different people from the company that came in, they might have a copy of the individual explanation of benefits there for you.

Q. Okay are there any times when you advise people that it's not really a good idea to appeal something?

A. The only time I I would and I don't like to because I think anything should be fought, but if it's something truly cut and dried in the plan written it is not covered. It's very very hard. When it's vague, fight it. If it's not mentioned, fight it. But if it specifically says this plan does not cover this, it could be very difficult to fight something. It's all by the written word I find and certainly I look for any loophole that I can.

A. I agree and that that is what gave us our chance is that it said in our plan that they did not cover hearing aids and they did not cover an ear as an artificial limb, but it didn't specifically exclude a Cochlear implant.

A. Exactly.

A. So I said there is our opening. We can do this.

A. Exactly. When you knew you couldn't fight for the hearing aid because it specifically said it didn't cover that. But then when she had the surgery, that was a whole other there was the loophole. And you have to grab onto those loopholes and just like the Carter family did not let go and just keep fighting.

A. And I would like to say about that chart, I started one of those charts last year and I would recommend that to anyone because we just make a copy of that then for our tax person and all I have to do is send that to her as well for any medical that we can deduct on our taxes as well. So it's helpful not only for us for keeping track of what's going on, but also for our tax person.

Q. Again for the audience, it's important to know that if there are medical and disability related expenses for your child that exceeds a certain percent of your income, I believe it's 7.5 percent and you have all the documentation that you're paying for this out It's really important to keep track as you're keeping track of all the insurance paperwork. And again when you go to our resource section, we will have some more information about that. Barbara, would you like to say anything about tax deductions?

A. The only thing I would like to say is be aware that even over-the-counter items are tax deductible if they're medical.

Q. In the work that I have done with families, I advise them that the first time they do this, they get a letter from the child's doctor saying I am the doctor who is treating John Doe with his birth date and Social Security number. His diagnosis is and have the doctor list that and I have recommended the following treatments for to the family for his condition. And send that in with your tax return so the IRS will be aware of that.

A. That's excellent.

A. Yes we've kept track of different even types of toys that we have had to get for her home therapy.

Q. I would recommend that you get a note from the therapist that they recommended these specific items.

A. I was thinking the same thing.

Q. Yes and the reason for them and attach your receipts to that. They are not things that you otherwise would have purchased for your daughter.

A. Exactly.

Q. It's also important for the families to know that your travel to the medical and disability-related appointments can be deducted if you keep records as well as your parking if you

get receipts. And for a lot of families, there are some things that will never be covered by insurance, even if you appeal and sometimes a tax deduction is the only thing that's

available. So it is really important to know about this. A. And when you're reaching that that level of that 7.5 percent to start deducting, then everything does become very important.

A. Even the tolls.

A. Yes.

Q. I know what I do at home is I have a big envelope that I start every January and I put all the receipts in there for medical deductions because it's impossible to recreate this on April 14th. You have to do it consistently.

A. Oh definitely.

Q. Mark the mileage down on your calendar every time you go to an appointment. I actually now I have a chart of all of the different providers and what is the mileage to their offices.

A. And as we said before, if you have a notebook, just automatically like a diary, just put everything in there and then you can always look right back into that book. You can even keep your receipts in that book.

Q. So I think we're getting close to the time when we have to close, so I think we need to summarize about being persistent and Cheryl has given us an excellent example of a very determined consumer who is very methodical, very persistent, very determined who was able to access care needed by her child and Barbara has really given us a lot of practical advice from her many years of working with consumers and helping them deal with insurance. I would like to ask each of you if you have any things that you'd like to share with the audience in closing about understanding, accessing and appealing your benefits. Sheryl?

A. I would say again to be persistent. Again as we talked about you know how far you can go by reading your book, contact someone. I wish I would have known of someone like Barbara to contact and for help. Look through books. But try and find resources every day. They are putting more and more resources out on the web. There are a lot of places out there based on your income that will help you. We've been very fortunate and have had some places help with some assistance for us and again just be persistent, write letters, read and take the time that you need. What you put in is what you'll get out.

Q. Barbara?

A. I certainly agree and I think Cheryl's just a wonderful example of how someone can be successful. Don't give up. If you feel that there's a chance that that loophole is there, grab it and most important as we said all the way back in the beginning of this conversation, know your benefits. Be aware of what you need to do, what your plan pays, how much is out of pocket, and what you can expect and then just fight and call. Keep track of everything and fight every day.

Q. Okay well I want to thank you both very much for taking time out of your busy schedules to share your expertise with us and with other families who have children with special health care needs. This is a very important topic and I'm very grateful that you were able to give it so much attention and thank you again.

A. Thank you, Cheryl, good luck to you. You are wonderful and your daughter's very lucky to have you.

A. Well thank you. Thank you very much and I'm sure your clients

are very lucky to have you and again I wish I would have known

there was someone like that out there so I think this is great

that there your name is going to be on this website and

hopefully people will contact you for help who don't know what

avenues to take who may not be as pleasantly pushy.

Q. Wonderful. Thank you very much.

A. It was wonderful doing this.

Q. Well thanks to both of you.

End of interview.

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