What Can You Do If You Are Denied an Insurance Claim?
There may come a time when you really need an insurance claim because of some trouble that came up. But what should you do if you find your claim is denied? This is something that happens more often then you would think. Instead of sitting there and taking it, you need to do something about it. Here are some ways you can get that claim reversed.
Reverse a Denied Claim
It may seem untrue, but the more chronic your illness the more likely you will be denied a big insurance claim. If you require medical visits that become quite frequent this will have a negative turn on your claim. This is because insurance companies really do not want to pay any money, and the more they can get out of the better.
Look Over Your Plan
You need to get a copy of your plan. Get every page and make sure it has every detail. They you need to go over the whole plan and note what coverage you have been denied. Then see if you can find a place that talks about denied coverage or under what circumstances you will not have any coverage. Sometimes companies can deny your claim because they can write it off as experimental. In this case a lot of companies do not cover experimental treatment because it does not have a solid history, so they are not sure what it will do. This can also be a good excuse for the company, however. At this point you need to write them a letter about this topic.
When you are done with that you need to go back and talk with your doctor. There is usually someone in each office who handles insurance issues. Let them know that you have been denied and you need to do something about it. They will help you get information together so you can show the insurance company that your treatment was required, not experimental. The doctor will let them know why you need the treatment, why the doctor assigned this medication, and all the good it will do for you.
When all this is done, then make sure you have all the correct documents. Then make sure you copy them for yourself, so if they have any questions you will be able to consult the paperwork. It usually takes about 30 days for them to come to some sort of conclusion. So note when you turn in the paper work, and then know when the 30 day period is up. At this point you need to follow up with them. If they keep forgetting to give an answer, and then make sure you get on them. Do not be forgotten in this process. Because they are busy and your work might get lost.
If this does not work, then you can file an emergency appeal. This will be covered at some other time.
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