Many times it seems that Health Insurance companies deny claims in hopes that you won’t file an appeal. They are in business to make money after all.
If you have read your health insurance policy you should have a pretty good idea of what is covered and what is not, but if you are like most people you really have no idea of what’s covered and what is not.
What you most likely have an idea of is what your deductibles are, and especially what your co-pays are.
Other than that, most people just go along with what the insurance company pays and figure out a way to pay the rest when they get the bill from the doctor’s office or hospital.
So when should you appeal a denied insurance claim?
Whenever you feel the amount you are having to pay out of pocket is more than what should be fair.
How To File A Health Insurance Appeal
(courtesy of The Consumerist)
1. Double-check all the rules of your insurer’s appeals process, especially deadlines.
2. Get all your documents ready and organized.
3. Call HR if you get insurance through your employer. They might become your advocate.
4. Ask your doc to write a “letter of medical necessity” and send it to the insurance company.
5. Make a log of all your calls when you contact the insurance company, including dates, times, whom you spoke to, what you talked about, and the length of the conversation.
6. Write down and refine your logical argument for why your claim should go through and refer to it when necessary throughout the process.
7. Keep checking on the status of your claim with the insurance company.
Things of this nature demand attention. If you do all of the above and then just forget about it without constant (bi-weekly) follow up then it’s likely your appeal will go no where and you’ll be stuck with the bill.
Stay on it until you gain satisfaction that your insurance company has paid all of their contractually obligated amounts.