Health Insurance Policy Claim

Reader’s Question:

My appeal for claim was denied by my health insurer. Do you have any tips on how I can effectively file my claim?

Melanie

Henderson, NV

Very good question, Melanie.

This has happened to me too and it took me almost 6 months before my claim was approved. If I could turn back time, I should have done it better. From the accounts of my experience, I can give you very sensible tips which you might want to pick up from.
For one, you need to make very detailed records of every step that you do. When you make a phone call, make sure you write down the names of the people you talk to, the date of call, and everything that was said in the call. You can make a follow up letter summarizing the conversation. It is best if you keep copies of all records including every notice and piece of correspondence whether by letter or email.
You can challenge your insurer point by point by making them write to you all legal and medical justifications for your denied claim. In writing, the insurer needs to cite a specific point in the policy and if they can’t then their denial can be invalid. Check the medical background of the person who made the ‘denial decision’.

You should state in your appeal several key elements that can make it strong such as the list of treatment or service you need, the date the treatment was stopped or denial of coverage, plan’s reason for denying treatment, and your reason why the denial should be overturned. You should state these elements even if your insurer does not ask you for it.
Most importantly, you have to file your appeal on time and with a duplicate. Despite the fact that you are as convinced that your appeal is right, always be courteous to everyone. By being so, you might cut your agony a little shorter.