Ensuring a voice for the sick

Story written by Adria Goldman Gross


Often what you suffer in this world can open the door to fulfillment — for you and others.

Three decades of charting a course through epilepsy — along with my experience in the insurance business — have enabled me to help others navigate a sea of red tape, particularly the less fortunate.

And it all began one day in the 1960s when I — a blooming teen in the age of Flower Power — fainted in religion class.

When I woke up in the hospital, my family and I were told I had epilepsy — and it would be with me the rest of my days. I was going to have to watch my diet, take medication and try to sense when a seizure was about to hit. Life as I had known it had taken an unexpected turn.

Happily for me, all was not lost. Avoided by “normal” children, I became a confidante of two other girls on the outside looking in — one was black, the other blind. In our own small circle, we accepted one another’s differences the same way the “normal” kids accepted themselves. We certainly made a curious trio at the senior prom.

I went on to college, where compassionate students were willing to room with me despite my medical condition. After graduation, I found understanding employers and work in Manhattan’s Garment District. But the seizures continued — sometimes as many as 20 a day, with some lasting a few minutes, others an hour or more.

After years of seizures and taking 32 pills a day to control my condition, I started researching a surgery where the part of the brain that caused the epilepsy — in my case, the left frontal temporal lobe, which is involved with cognitive and language functions — could be removed. The operation had a 60 percent success rate, but my desire for a life without worry was stronger than my fear of the operation. Mom was my rock and, thanks to her support, I found a specialist, had the surgery — and waited to see if I would be in the 60 percent.

Six weeks after the surgery, the right side of my brain took over for my diminished left hemisphere. No more seizures, no more massive doses of medication. I could drive a car. I could walk down a street with confidence. I could go to work without worrying. Maybe meet someone to love?  Have children?  I did indeed get married and adopt two wonderful children from Vietnam. My new job became that of a full-time mom — baking cookies, going to play groups and cleaning up toys. When I put the children on the school bus, it was time to go back to work.

Since many of the jobs in the Garment District had been shipped overseas, I applied for a position with an insurance company, where I was trained to reject claims automatically.  As my career flourished, I learned the ins and outs of the business. First and foremost, the goal was to get rid of the claimant.

But a friend asked me to help with a claim that got rejected. All the knowledge I had gained enabled me to get his bill down to 80 percent of its original total, saving him several thousand dollars.

That was a light-bulb moment. Could I do what I had done for my friend and make money doing it? With help from SCORE (score.org), a retired professionals mentoring group, I walked through the steps that allowed me to open my own business.

MedWise Billing Inc. was born in 2006.  My clients trickled in but soon become a steady stream. Anyone — and, it seems these days, almost everyone — has had a standoff of some sort with an insurance company, whether it is an incorrect charge or a rejection of a claim. Navigating the insurance system can be a hair-raising experience, especially when you are not feeling your best.

Four years ago, I added another component to my business, MedWise Insurance Advocacy, in which I act on behalf of patients who are in distress both physically and financially. Often, they are facing foreclosure. MedWise Insurance Advocacy has given me an outlet to give back the blessing of all the people who helped me along my journey. It’s also inspired my new book, “Solved! Curing Your Medical Insurance Problems” (Outskirts Press, $13.95, 108 pages). Such advocacy is probably the most emotionally rewarding part of my business.

Today, the years of being on the outside looking in have taught me a valuable lesson: You never know a person until you’ve walked in his shoes. Walking in mine has allowed me to help others reach their destination, which makes me love what I do all the more.

For more, visit medicalinsuranceadvocacy.com.

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