Health insurance is a hot topic in the media right now. Regardless of how Obamacare plays out, struggles with insurance claims will likely continue. One contentious issue: fighting for coverage after a health insurance company denies coverage of a medical procedure.
Those who find themselves in this position have options.
Before the procedure
The first step to receiving full payment is avoiding denial in the first place. Before receiving a procedure, treatment, therapy or other medical intervention review your policy. If the policy is unclear, contact the company and ask for an explanation. Take detailed notes of this conversation, including the name of the representative as well as the time and date of the conversation.
Next, be sure to follow the rules. If the policy requires preauthorization before a procedure is covered, get the authorization.
After the procedure
Sometimes, even after taking all the right steps to help better ensure a procedure is covered, an insurance company will still deny a claim. Insurance experts with Bankrate admit the first step to fighting back after a claim is denied is proper organization. Review all bills issued by the hospital regarding the procedure or treatment in question. Once you have an understanding of the procedure, review the details of your policy.
Next, call the customer service number provided on the insurance card and ask for the representative to explain why the claim was denied. If the representative is unable to help, request to speak with a supervisor. In some cases, the representative may claim the reason for denial was a hospital error. If this is the case, call your medical provider and ask them to correct the mistake. This could mean the wrong code for the procedure was entered into the billing system. After the change is made, ask the hospital to resubmit the claim.
In other cases, the rejection turns on whether or not the procedure was "medically necessary." In these instances, it may be advantageous to have your treating physician write a detailed letter of explanation to send to the insurance company.
Additional measures available to receive compensation
Even after taking these steps, some insurance companies continue to deny coverage. Unfortunately, medical bills can be extremely costly. These bills can drain your savings accounts and cause serious damage to your credit rating.
If you believe your claim was wrongly denied, contact an experienced medical claim denial lawyer to discuss your case. This professional will be able to discuss your situation and help you decide the best course of action.