How to Deal With Your Health Insurance Company

Claim denied? Here are three simple strategies to try if your insurance denies payment for life-changing treatments you or your child require.

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.

Your Parent Has Dementia: What to Talk to Their Doctor About

Make sure all their doctors are aware of all the medications she is taking.

Q: My mom is 94 and has dementia. She is taking a whole medicine cabinet-full of medications and I think they actually make her fuzzier. How should I talk to her various doctors about what she is taking and if she can get off some of the meds? — Gary R., Denver, Colorado

A: Many dementia patients are taking what docs call a "polypharmacy" — three or more medications that affect their central nervous system. And we really don't know how that mixture truly affects each individual person.

A new study in JAMA Network that looked at more than 1 million Medicare patients found almost 14% of them were taking a potentially harmful mix of antidepressants, antipsychotics, antiepileptics, benzodiazepines such as Valium and Ativan, nonbenzodiazepine benzodiazepine receptor agonist hypnotics such as Ambien or Sonata, and opioids. And almost a third of those folks were taking five or more such medications. The most common medication combination included an antidepressant, an antiepileptic, and an antipsychotic. Gabapentin was the most common medication — often for off-label uses, such as to ease chronic pain or treat psychiatric disorders, according to the researchers from the University of Michigan.

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