Sunday, April 19, 2009
Back in 2002 during the dotcom crash, I worked for a start-up company in Los Angeles. We had grown from 10 to 200+ employees in four years, and it was challenging and exciting. I moved up quickly, because I had such passion for the work, ran with the opportunities given to me, and took complete control of my tasks, always delivering in this very fast-paced environment.
After acquiring another company and changing our business direction, we started to go through layoffs. By the fifth round, which was purely salary-based, I was gone. The woman who hired me and mentored me throughout my employment (who I remain very close to) had left a year earlier. When she found out I got laid off, she was very upset. I moved to San Diego just following the layoff, and lived with friends until I settled in. About four months later, a letter arrived from my mentor. I would like to share it with you here. I just re-read it after 7 years, and it still resonates as much now as it did back then.
“This is not a loan. This is a gift. I purposefully am sending a money order to be sure that you will accept it/cash it. Again, it’s not a loan. It’s something I want to do for you because I really care about you and have been very sad with the turn of events in your life. At the same time, I am heartened by your spirit and your refusal to give up. I ask two things of you. When you are able and however you can do/choose to do it, pass on the gesture to someone in your life. This does not necessarily need to be with money. It is whatever gesture is right for you. Second, please try to adopt this prayer into your daily prayers; it has helped me so much, especially when I was in big transitions."
"God, help me to see the opportunities you are putting in front of me. Help me keep my eyes open. Help me to live not by my will, but yours. And when I see it, give me the courage to act on it. I trust that you have a plan for me God. Help me see it, help me realize it."
Whether you are spiritual or not, there is a message to take away. Being a Gumptionista is not just about fighting for yourself or your cause, but often fighting for others who may have lost some of their fight. It's not always about giving money, but providing direction, reassurance, and a listening ear. Now is the time to offer a helping hand, however you can.
Sunday, April 12, 2009
"Dear Gumptionista: Thank you, thank you thank! Your advice worked! I faced a terrible dilemma. I bought plane tickets to Hawaii for my upcoming honeymoon, but when I went onto the airline's website one month before our trip to check on our flights, I faced a screen that said "this airline has filed Chapter 11 and all flights are cancelled. Click here for more information." The airline was neither willing to transfer any flights to sister airlines, nor refund any purchases. I was devastated! This was my h-o-n-e-y-m-o-o-n. I e-mailed you for help and you gave me sage advice: Send a letter to the CEO asking for a refund and explaining my personal situation, and do not take no for an answer. I was hesitant because I thought there was no way I would see any money back. It seemed overwhelming to "fight" a bankrupt corporation. I usually don't do this type of thing. But, for once, I was fired up by the "Gumptionista's" words, and I followed through. It took a total of one e-mail, one file claim, and a little patience (6 months to be exact). Sure, the company sent me endless court documents about the current bankruptcy case. But, my claim stayed unfazed and intact.
Yesterday, after a long day of work, I came home to find a full refund check in my mailbox! Maybe now I will go on a honeymoon. Thank you, Gumptionista!-a fan."
If you can get a full refund from a bankrupt corporation, then anything is possible. Fight, fight, fight for what's right!
Tuesday, April 7, 2009
Have you ever wanted to fight a corporation, but didn’t think you could win so you said the heck with it? Well, I am living proof that if you are persistent, patient, and you plead a logical case, you will prevail. I hope this story convinces you that you can fight and win, and be the tenacious gumptionista you were born to be!
In 2005, I had a bilateral reduction mammaplasty surgery. Basically, I came out of the womb a DD-cup, and it was starting to impede on my life. There were certain pre-surgery criteria I had to meet in order for the surgery to be covered by insurance: height/weight requirements, a letter from my doctor and chiropractor indicating the need for the surgery, and the insurance company needed to see a photograph of my naked chest (still not sure to this day why that was necessary, but grateful the pictures haven’t resurfaced on the Internet). A few weeks later, I received an acceptance letter from the insurance company. They said that there was, however, one more piece of criteria that had to be met post-surgery. Insurance required that a certain amount of tissue be removed. My doctor explained to me that if he removed the amount of tissue that they requested, I would be disproportionate. With that being said, I authorized my surgeon to make his best judgment, and I would take on the insurance company later. While I was recuperating, I decided that there was no better time than the present to send a letter to the insurance company. I sent the following to the President and CEO of the health insurance company:
“The problem I am about to state has not arisen yet, however, I fully expect it to present itself in the very near future. I had mammaplasty surgery one week ago, and although you pre-approved the surgery, the amount of tissue removed was less than the allowable. Although I have not yet received a rejected claim, the fact that the insurance company was adamant that the claim rely on the amount of tissue removed, I fully expect to receive the rejected claim any day now. I feel a great relief from the surgery, so I am not sure why the amount of tissue removed should be determined by the insurance company. Shouldn’t you base it on how the patient feels? Do you think a woman would go through the emotional and physical pain of having surgery if they didn’t have to? This is a major surgery, and no surgery is deemed reasonable unless it is going to help you physically. I am not the type of person to just go away. I am relentless and will continue to fight this for other women, and change the insurance policies, law, etc.”
As fully expected, I received a letter three weeks later rejecting the claim because “the surgeon removed less than the amount of tissue that was authorized.” I then sent another certified letter to the CEO and President of the insurance company.
“I sent a letter to you on 8/25/05, which addressed a recent mammaplasty surgery, and the fact that the claim would most likely be denied. In December, I received a letter from indicating that, in fact, the claim had been denied. Just as I had stated in my letter to you, the amount of tissue which was considered “allowable” was not removed. I further explained that the surgery had changed my life, despite that the “allowable” amount was not removed. I understand that insurance companies need to have some standards for approving and rejecting claims however, this is ridiculous. For you to make a determination on how much tissue needs to be removed to make me feel better, is unacceptable. I trusted my surgeon to make the right decision. He is the person that should determine what will relieve my pain. I will continue to fight this and will be going to the medical board to change this approval process for other women. I would appreciate a response, as I would hope you are taking your subscriber complaints seriously. We are the backbone to your business, and do have a say in how our employers choose their providers.”
In February 2006, I received another letter denying my claim. Now the insurance company was indicating that “the services have been determined to be cosmetic and not medically necessary.” Interesting how they have now completely changed the reason for the denial. At the end of the letter it said that I had the right to request an Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC). The fight has now just begun!
I went to the website and downloaded the IMR application. In the application, I said that the issue is not with the claim being denied, it is with the way criteria is established for these surgeries. Three weeks later, I received a response from the Center for Health Dispute Resolution. The CHDR is under contract to perform an independent medical review. They employ doctors and health care professionals who study the case file and medical records to decide if the claim is medically necessary. The report said, “the patient underwent the procedure to relieve her documented symptoms. It was therefore medically appropriate and indicated. The patient indicates that her symptoms were relieved by the procedure. That a smaller amount of tissue than authorized volume was removed does not negate the necessity of the procedure, and as such, the health plan’s denial should be overturned.” Hallelujah, Hallelujah, Hallelujah!!! Am I dreaming? Did a doctor of sound mind really say that I was right? Within two weeks, I received an 80% reimbursement.
The key to fighting a corporation is:
- Document the situation. As soon as you realize there may be an issue, be sure to document everything including names of individuals you spoke to, the dates of the phone calls, and dates and copies of all correspondence.
- Certified letter to CEO. Send correspondence, certified, to the President or CEO of the company. You will always receive a response.
- Clear and concise correspondence. In your correspondence, be clear and concise. Ask for what you want and always include the fact that what has happened is “unacceptable.” I am not sure why that word has so much power, but it does.
- Consequences. Include a consequence if the issue is big enough, and be prepared to follow-through. In some situations, I have said that I will contact the State Medical Board, consumer advocacy agency, or an attorney.
- Be reasonable. If you truly believe in your heart that what you are asking for is reasonable, then it probably is. If you are writing to an airline because you had a bad experience, but you are asking for two first class tickets around the world, you are setting yourself up for rejection.
- Give them a timeframe. If you expect to hear back from someone within 5 business days, let them know that. Indicate what will happen if you don’t hear back from them in the timeframe you requested.
- Documented back-up. Always request that they get back to you in writing. This way you will always have backup.
- Be patient, but persistent. Companies have all the time in the world to continue to deny your issue/claim. It doesn’t matter to them if they fight you for a year.
- Stick to your guns. Stay on top of it until you get the response you want, and only accept no, if you can live with it. If you no longer have the energy to fight, then it’s time to stop. Remember though, it may only take one more letter to resolve in your favor.
Thursday, April 2, 2009
Although 90% of the SUV’s license plate number was embedded in my bumper, it wasn’t enough for the police to identify. I couldn’t believe that in bumper-to-bumper traffic, not one person took the time to write down the license plate number of the car who hit me. From that day on, I swore that if I ever witnessed a hit and run, I would do the right thing, and almost a year to the date of my own accident, that’s exactly what I did.
Wednesday, April 1, 2009
About an hour later, I got a call from Officer Canterbury, indicating that the same car had hit another vehicle and the man left the car at the scene and walked home. I was asked to come and identify the man, who was drunk out of his mind, standing in his yard with another officer. I positively identified him and he was taken into custody. I received a call from Officer Canterbury later that night, thanking me for taking the time out of my day and doing the right thing. Apparently, I was the only person who came forward and this man went to jail for DUI for the second time for hitting three cars that day, drunk. I thought at that moment, I have on my Gumptionista bullet proof vest and as long as I was doing what I believed, nothing and no one could hurt me.
When I think of the word Gumptionista, I think of a “gutsy broad.” It doesn’t matter if you’re single, married, divorced, old, or young. It’s an inherent quality of taking charge, going after what you want, and not being afraid of standing up for what you believe in. The word most reminds me of my east coast, Italian grandmother, who has never been afraid of anything and who at 82 years old, won the fight against breast cancer. Several years ago, my grandmother was jumped in a mall parking lot by two punks. They pushed her to the ground and pulled at the gold jewelry around her neck. She calmly looked up at them and said "you little bastards, I got a good look at your face and my husband is in the mob." My grandfather wasn't really in the mob, but that seemed to be a good thing to say at the time. It seemed to work, because it didn't take long for those guys to take off running. My grandmother, who is all but 4' 11", stood up, dusted herself off, and went on her with her day. I’ve always admired her strength and whenever I start to have a weak moment, I think about the essence of my grandmother, and I immediately snap out of it.