When a Health Insurance Company Denies Treatment (2:30)
If your doctor has recommended a certain treatment, the last thing you want is for it to be held up because of red tape from the insurance company. Here’s how to handle a claim that your insurance company has denied — and how to avoid claims being denied in the first place.
Call Your Insurance Company First
This first tip is easy, but hardly anyone does it. Before you have a procedure or visit the doctor’s office, call your insurance company. Ask them to acknowledge — in writing — that they will cover the procedure. That way, the insurance company can never deny payment or deny your claim in the first place.
Always File an Appeal
If you’re denied coverage by your insurance company, always file an appeal. As the saying goes, you miss 100 percent of the shots you do not take. If you do not resubmit your claim, you’ll never know if the insurance company would accept it the second time around. And, in fact, more than 70 percent of claims get accepted the second time around, so the odds are in your favor.
Find a Patient Advocate
Let’s face it: The language used in health insurance correspondence is difficult to follow, and the rules around what’s covered — and what’s denied — are hard to understand. If you are feeling overwhelmed, one option is to hire a patient advocate. Patient advocates typically have a background in health care. They can help you understand the lingo, doing everything from reviewing insurance paperwork to accompanying you on doctor’s visits.