Health Insurance Woes

There is a great article in Parade magazine today (http://www.parade.com/articles/editions/2008/edition_01-20-2008/Fight_for_Your_Health_Care). It has a lot of helpful information in it.
As noted previously, my husband and I have been to lots of doctors and hospitals recently as he is a recent liver transplant recipient. Thank God for the miracles of modern medicine.
Now, the subject of health insurance is another matter entirely. Dealing with these people has been the most stressful part of this whole transplant. I believe, with all my heart, that these people "deny all, permit by exception" in computer geek terminology.
I do have to admit the insurance company, by causing the stress that they did, helped alleviate much of the stress of dealing with the transplant need itself, the evaluation, the waiting, and ultimately the transplant itself. The insurance company was, and continues to be, MUCH more stressful.
If you happen to have doctors that don't have the staff to help you deal with these folks, then you're pretty much out of luck unless you can afford a lawyer or, as noted in the article, obtain help from an advocacy group.
To start with, this company denied the initial 11 day hospital stay for this man. We arrived home to a letter waiting for us that said denial of claim. When I called the number provided to find out why, I was told they couldn't provide that information to us; the hospital would have to contact them. (No good response to the question of why they provided a phone number for help if they weren't going to provide any help.) So I called the hospital billing office, who called the insurance company, who said, no, since the claim was denied, we need for the doctor to contact us to go over, line item by line item, all of these charges. Yes, we were probably wrong to deny this claim, but procedures you know. Hospital calls me to tell me what the insurance company said and to get me to call the doctor. Turns out that, indeed, after the nurse practitioner finally got in touch with the proper person at the insurance company (took several days, the insurance company is busy after all) and spent over an hour going over the bill line item by line item, that indeed, the insurance company could pay this bill.
Some version of the above has occurred with every single claim that has been filed since August 2007, including the necessary prescription drugs. Turns out the prescriptions are covered, there just happens to be 3 different divisions that the prescriptions have to go to and guess who is magically supposed to know what to send to who? All of these divisions are part of the same company, but apparently do not know how to, or won't, communicate with each other. Procedures, you know.
We were called 3 times to come to the transplant center for the surgery. The first 2 times we were sent back home after preparation for the surgery. Stressful enough, right? Wrong. Insurance company denied these claims. Guess they thought we made these trips for the fun of it.
Finally, after 5 months of trying to obtain help from the company, it turns out that if you complain enough, you get assigned a patient coordinator. The patient coordinator got all of the denied claims taken care of and has been great help with every other issue that has come up. While I appreciate this person very much, I will be contacting state and federal government officials to see what I can do to help change these practices. From stories I've heard, I actually made progress much faster than most folks.
"Deny all, permit by exception" is a great concept for computer network security; it is not even close to a mediocre concept for health care benefits.