Health insurance is a necessity. Medical costs are outrageous and any serious illness can send someone reeling toward bankruptcy. When a claim is denied it is always a stressful situation. However, panic does not help the situation. Gather up all your paperwork. Locate your health benefits guide and get prepared for a telephone conversation.
The first call goes to customer service of the insurance company. Have paper or take notes on the computer about who you talk with and what was said. It is a good idea to read the notes back to the agent to make sure there are no miscommunications. Many times it can be a simple coding error and the denial may be taken care of at this level.
The next step in the appeals process is to alert the insurance company in writing that you are appealing the denial. Be sure to include a copy of the notes from the conversation you had with the customer service department. There is usually a form in your insurance handbook to complete. Most of the time, you have signed an agreement that no legal action can be taken and all disputes will be handled through arbitration. If you are unsure about this check your documentation, or call customer service and ask.
Be prepared for this process to have a great deal of paperwork and take some time. Request that no late fees be placed on the amount owed as you are appealing the original denial. Most of the information requests that will come from the insurance company will have clear deadlines; these are nonnegotiable. Be sure to be prompt and give them all the information even if they have requested it before. There are times when the arbitration committee will request identical information.
Get itemized copies of what you are being charged for. Sometimes there are excessive charges for items and you can get them removed from the billing. This shows the insurance company that your are being thrifty with their funds as well.
Get information from the physician which states the medical purpose of the treatment and any notes they have that might be pertinent to the case. Doctors often have no idea what the insurance situation is. Their job is patient care.
Be professional. While this is often a very emotional time, try and keep it professional. The people will respond better to facts and information than emotional pleas. Hopefully the issues can be resolved in a professional and timely manner.