Have you ever had your health insurance company deny all or part of your medical claim? If so, you are not alone. Thousands of people everyday have disagreements with their health insurance companies. Here are 7 tips to fight your health insurance company when a problem arises.
1. Documentation will be your number one ace in the hole when fighting with your insurance company. They can’t dispute what’s written in black and white. Of course, neither can you. So be sure that you understand what the documentation states beforehand, and try to organize it chronologically for quick and easy reference.
2. Contact the physician or medical facility that provided you with service and ask that they provide you with a detailed printout of what services were provided and how much each one costs. This is actually a good practice to get into for any medical attention you’ve been provided with. This information will help you to explain your disagreement more easily.
3. Make sure the insurance company doesn’t drag their feet about processing your claim or the appeal. You are entitled to a legal window of time in which you can dispute a decision by your insurance company or file a lawsuit, if it comes to that. The insurance companies know this, and will do what they can to close that window of opportunity shut.
4. Be polite, and don’t threaten the representative whom you’re dealing with. Not only are they only doing their job (even if they disagree with the insurance company’s policies) they are the people who will most likely be able to rectify the situation you’re dealing with.
5. Be prepared to thoroughly explain your reason for the dispute. This is why it’s imperative that you have a copy of your insurance policies, and that you understand what your rights are. The insurance policy is the legal agreement you and your insurance provider have with each other. You must adhere to what is says just as much as they must.
6. If after presenting your case to the insurance representative you still disagree with the results, file an appeal immediately; and keep filing them until you no longer have a legal right to do so. The odds of your insurance company reversing their decision increases each time someone new reviews the case. This is not a guarantee that you’re dispute will be resolved in your favor, but it certainly ups the odds.
7. Finally, the best for last. Have you ever heard of something called Prompt Pay? No? Well, that’s because your insurance company doesn’t want you to know about it. Prompt Pay means that if your insurance company fails to pay your claim in a timely manner then they must pay interest on the balance owed. Talk about poetic justice! This interest may be paid to either you or your medical provider, but in either case, your insurance company won’t be too pleased with the prospect of shelling out money. After all, they’re in the business of making money. Not all states have Prompt Pay laws so check with your state before playing this card.
Maryellen Ward writes about how to apply to a masters in health care program online.