One of the biggest hassles in any medical situation can be dealing with your insurance provider. Far too often, we find ourselves fighting in order to obtain the rights that are spelled out to us in our insurance contracts. Unfortunately, many insurance companies rather than give us what we are entitled to, which we have paid for, they would rather fight us for each and every penny. This of course is somewhat understandable as they are indeed in the business to make money, but there are tiems when it would be nice to just have an insurance company work with you, admit that they owe the money, and resolve the issue promptly.
Over the last few years, I have had to work around the insurance company numerous times. As a member of the military, I have one of the best medical plans you can get through TriCare. While we normally don’t have to deal with TriCare because we see our on installation doctors, bypassing the entire system, there are times when going on base just isn’t possible. For those times you have to work directly with your insurance company and the qualified providers in which they recommend. This can at times be a relatively easy process or a nightmare.
When my ex wife was pregnant with my son about two years ago, she had found out that she had A- blood. Apparently, with this type of blood the body could potentially reject the baby unless the mother received injections on a somewhat regular basis. During her pregnancy she found herself in Michigan and would require a shot while there. We made sure that she went to an approved provider, got a recommendation letter from our home of residence doctor, and then proceeded as required. We dealt with it like we would with any other medical visit after that. About two months later however, we received a bill in the mail from the hospital stating that our insurance refused the claim as being not a necessary treatment. This of course was far from the reality of it. So rather than paying the bill ourselves, we talked to the insurance company and our on base legal counsel and found a variety of ways in order to resolve the issue and dispute the insurance claim.
First you can fill out the paperwork and go directly through your insurance company. Most insurance companies allow for written disputes, and some even allow for over the phone disputes of claims against their findings. Sometimes with a little bit of additional information, the dispute will be handled and the bill will be promptly paid. But before you get into this process make sure that you read through your policy carefully and make sure that your treatment was indeed covered. If it wasn’t then you could find yourself wasting a lot of breath more than anything.
Next, AFTER you file your dispute, you can take the claim up with the courts. The court can then release a judgement either for you or the insurance company. If you are right, make sure that you can prove that you followed the appropriate steps and make sure that you can find in your policy where it states that it will be covered specifically if at all possible. They will try to show you where it states that it will not be covered. In many of these cases you can represent yourself, however if it is a large enough amount, I would talk to an attorney and have them fight the battle for you. They are much more likely to be able to win the battle and could potentially get you more money than even the bill represents.
Finally, you could just pay your bill. Often times you are going to want to just do this anyway because if it goes without payment for long enough, the only person that it really effects is you. You definitely don’t want a medical claim on your credit report, because it will drastically reduce your ability to obtain credit, especially if you’ve never had a charge off in the past. Just keep track of any costs associated with the payment of this bill in order to present that in your case against the insurance company as damages. These could ultimately be rewarded back to you as well.
Just make sure that when dealing with an insurance company that you know your policy and that you are aggressive in pursuing them. Most insurance companies get off the hook by consumers because consumers just don’t know their rights. Be informed and you’ll be able to take on even the largest of insurance companies.