Resources to Help Fight a Denied Claim

Approved or DeniedYou just got a letter from your health insurance company. They have denied your claim and are expecting you to pay out of pocket for something that you believe should have been covered. What can you do about it? One option is to fight the claim. Here are some resources to help you do that.

The reason why you got health insurance was so that you would not have to pay all of your medical bills out of your own pocket. Instead, you pay premiums to your insurance company. You might also be paying a co-pay when you visit a doctor. You could be paying down a deductible before your insurer will start paying for anything.

It is frustrating when an insurance company denies your claim. Often, it feels like they are not living up to their part of the deal. It is possible to fight an insurance claim denial. If you are considering fighting a claim, you might want to read over some advice by Kaiser Health News, USA.gov, and HealthCare.gov.

Kaiser Health News has some helpful information. They link to a report from the Government Accountability Office that shows that fighting a claim may be worth your while. You can read over the entire report if you would like to.

Kaiser Health News suggests that you ask your doctor, or insurer, to cross-reference the treatment you received with the diagnosis and make sure that the two are in sync. It is possible that someone accidentally wrote down the wrong code.

USA.gov has put together five steps for “How to Appeal a Health Insurance Claim”. They point out that it helps if you keep detailed records of contact between you and your health insurance company. Don’t delete those emails! It is also a good idea to read over the booklet that came with your policy that specifically notes what is covered and what is excluded.

HealthCare.gov has a page that informs you of your rights as a consumer in situations where your insurance company denies a claim. You can use it as a “checklist” to see if your insurance company followed the rules.

HealthCare.gov mentions is that your insurance company is required to notify you of certain things when they deny a claim. One of those things is information about the availability of a Consumer Assistance Program (if your state has one). The Consumer Assistance Program is another good resource to consult.

Image by Joel Kramer on Flickr

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