Health Insurance Problems
Fighting a Health Insurance Claim Denial
If you use your health insurance, you might run up against a claim denial. It's usually worth fighting your denial. Fortunately, routes are available for disputing claim denials, including getting help from the government in many states. Sometimes your insurer will surrender and pay your claim to avoid the expense of handling an appeal.
What If My Health Insurance Doesn't Cover a Test or Procedure?
To make sure the treatment you need is covered by your health insurance, it is important to know your health plan's benefits. Make sure that you understand your options.
Insurance Codes - Learn About Insurance Codes to Avoid Billing Errors
Explanation of Benefits, insurance claim forms, and medical bills from your doctor or hospital can be difficult to understand because of the use of codes to describe the services performed and your diagnosis. It may be useful for you to learn about these codes, especially if you have a chronic health problem.
Hospitalized in Observation Status? You’ll Pay More
Hospitalized in observation status rather than inpatient? Learn why you'll pay more, the difference between inpatient and observation status, how observation guidelines work, and that paying more might be better than paying everything.
Are You Managing Without Health Insurance?
No health insurance? Share your story here. Tell us how you're managing your family’s health care needs and what you've learned that could help others.
Pre Existing Conditions - Have You Been Denied Coverage?
A pre-existing condition can affect your health insurance coverage. If you are applying for insurance, some health insurance companies may accept you conditionally by providing a pre-existing condition exclusion period. What has been your experience?
Customary and reasonable costs
What does "customary and reasonable" cost mean, and how will it affect payment for healthcare services?
Explanation of Benefits - How to Avoid Errors on Your EOB
Your Explanation of Benefits is a window into your medical billing history. Many doctors’ offices, hospitals, and medical billing companies make billing errors. Such mistakes can have serious long-term financial consequences.
Have Your Overpaid? Are You a Victim of Balance Billing?
Balance billing may happen when your health plan pays less than what your doctor or hospital wants to be paid. Your healthcare provider may demand the balance of the bill from you. Learn why this is inappropriate, and what to do about it.
A Consumer Guide to Handling Disputes
This helpful guide walks you through how to appeal a claims denial with your health insurance plan, and then escalate your appeal with your state’s insurance department.
Links to State Insurance Department Websites
You may need your state's insurance department to help you resolve a health insurance claims dispute. Find contact information as well as help for filing claims appeals on your state’s site.