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That’s Not What Donna Did

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Header photo: (left-to-right) Donna Bourcy and Dan Fremling

After working together for five years, this was the first time that Donna and Bethany had ever met. Unfortunately, it was under rather stressful circumstances.

“The claim got denied,” Bethany said, sliding a stack of papers across the desk. Donna took the first paper and read it. It was a letter from Bethany’s insurance company, denying the claim and they were billing her for a medical procedure she never agreed to.

“The claim got denied,” Bethany said, sliding a stack of papers across the desk.

“Oh no,” she said, thumbing through the sheets. In her mind, a resolution was growing. “Work hard, and do the right thing,” the Choice core value came to her mind. They were going to win this.

It was over a year prior when the issue began. Bethany, a long time customer at Choice Financial, had gone to the doctor for a routine check-up. In the appointment, they discovered that she had a mass in her stomach, and the ensuing biopsy proved inconclusive. The location of the mass made surgery difficult, and doctors advised against doing another surgery. Instead, they decided to wait, and watch.

In the meantime, they conferred with the Mayo Clinic to do some additional testing. The lab work also came back inconclusive. So, Bethany continued on with her life. She never got sick, and in every way felt healthy and happy. The mass didn’t bother her.

Then she got a bill in the mail, for over a thousand dollars. It was for the additional lab work.

“What’s this?” she asked her doctors, and then later, her insurance providers.

Apparently, the additional lab work was not covered by insurance because of the words “not a medical necessity.”

“How was I supposed to know that?” Bethany thought.

She had never agreed to additional lab work. She was never consulted on if it was a “necessity” or not. This was the doctor’s decision, and now it was her bill. She and her doctor wrote a letter to the insurance provider to try and appeal the denial. Her doctor explained how the mass could not be tested on, so the lab work was, in fact, very important. Those letters were denied.

That’s when she called Donna, a Client Account Executive at Choice Financial in Fargo. She was getting desperate.

“I’m losing sleep over this,” she said. “I’m worried sick about it.”

Bethany and Donna had worked together for years on the company benefits administration. Bethany is always friendly, with a positive disposition. She helps run a family business, and her work with Donna is quick and efficient.

Donna was distraught to see her friend burdened with something that was not her fault. Normally, she wouldn’t work with insurance claim situations; but in this situation, she knew she had to help.

“Bethany really shouldn’t have been held responsible for that additional testing,” she said. “She had no idea. It was wrong that she even had to worry about it.”

Right away, Donna began working on an appeal. Over the course of the next few months she worked with Bethany and her supervisor Dan Fremling, an Employee Benefits Manager, to write and send three letters: to the hospital, to the Mayo Clinic, and to the insurance provider. In each one, she outlined the situation and explained why this was simply not right.

“I don’t know how to thank you for all your work,” Bethany told Donna, over and over.

“Let’s just win,” Donna would reply.

In the final letter, Donna posed the question: if the lab work had come back cancer-positive, would this still have been denied?

“Of course not,” Donna said. “They would have never denied this claim.”

Along with Donna’s final letter, Mayo Clinic also stepped in and wrote a letter of their own. They were able to use the proper medical lingo to explain why the procedure was, in fact, a medical necessity. Then, they waited. Bethany first found out about the mass in February of 2016; at this time it was late August of 2017. She was ready for this journey to be over.

Then… on September 6, 2017, an e-mail came through to Donna’s inbox. It was from Bethany.

“We got it!” she ran to Dan’s office and shared the news. “They accepted the appeal!”

It was a huge relief. Later that week, Dan went to visit Bethany and she handed him a coffee mug and a card to give to Donna.

Donna showing off her new mug.

“Donna is amazing,” she said. “I’m so thankful.”

“Donna is amazing,” she said. “I’m so thankful.”

Dan said this is nothing new for Donna; he calls her the ‘social butterfly,’ someone who always ensures she is communicating well with all customers and goes above and beyond what is necessary,

“In this case, it would have been pretty easy to say, ‘That’s not our area of expertise, we can’t get involved. Good luck!’” Dan said. “But that’s not what Donna did. She truly puts People First.”