Few things are more frustrating than when your health insurance company denies your claim. No one wants to pay out of pocket for something that they were reasonably certain that their insurance company was supposed to cover. Often, people feel as though there is nothing they can do when this unfortunate situation occurs, except to scrape together the money to pay the medical bill. However, a study finds that it might be worth it for you to fight that denial after all.
You went through the long, tedious, process of applying for health insurance. Maybe you spent a lot of time reviewing what each different insurance companies could offer you so you could make sure your health insurance will cover what you, and your family, need in terms of health care. You’ve been faithfully paying your monthly premiums.
After all of this effort, it can be quite shocking to learn that your insurance company has denied your claim, and is refusing to pay the bill for the health care you, or your family member, needed. This is especially true if you had good reason to believe that your health insurance company was supposed to cover that exact thing. This is one of the reasons why so many Americans are unhappy with their health insurance.
Most people believe that there isn’t anything they can do when this happens. The general feeling is that it is not worth the effort to fight this denial, because, ultimately, the insurance company is just going to continue to refuse to pay anyway. It’s hard to go up against a big company when you are just one person. Surprisingly, a study shows that it really can be worth it to you to put up a fight if you truly believe that your claim is valid.
A study that was done by the Government Accountability Office (GAO), found that as many as half of all appeals that were made to some insurance companies caused the insurance company to reverse it’s original decision to deny a claim. It’s best that you make certain that your insurance policy states that it will cover the test, service, or care that was denied before you file your appeal.
One reason why an insurance company may decide to cover something it originally denied has to do with billing errors. It’s possible that someone at your doctor’s office accidentally wrote down the wrong code on the form it sent to the insurance company. The insurance company might think it is denying a service that you didn’t actually receive, instead of the one that you did have done. It’s also possible that the insurance company is having a misunderstanding about the health care that you received. In this case, a further explanation may be all that is needed to have your insurance company cover a claim that they originally denied.
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