Are you having trouble getting your insurance company to pay for your healthcare? Resolving health insurance claims disputes is a long, difficult process, but given the rising costs of medical care, it's definitely worth the effort. Here are some steps you can follow to maximize your chance of success.
Difficulty: Hard
Time Required: More than you think it will
Here's How:
- Gather all of your paperwork.
You will need the following:- Policy documents describing what is covered and what is not
- Correspondence from the insurance company denying your claim
- Doctor's and hospital bills
- Read your policy documents carefully.
You may be surprised to find that the medical services you received are explicitly excluded in your policy. However, in many cases, the healthcare procedure in dispute is either not specifically mentioned in the policy documents, or there is some grey area open to interpretation. Make a note of the sections of the policy document that specifically pertain to your situation. - Call your insurance company.
Explain to the claims adjustor why you believe your claim was denied in error. Make sure you get the name of the person you speak with, and do not hang up without getting a date by which your claim will be resolved. Call them back on that date if your claim has not been resolved. - Document all of your phone calls with the insurance company.
- Don't give up.
If your claim has not been resolved through your efforts with the insurance company, contact your state's department of insurance to file an appeal. Each state has slightly different procedures for appealing insurance claims denials - check here for the procedure in your state.
