Health Insurance Company Won’t Pay. Where Do I Turn?

By Robert Fredricks Posted in Health Insurance News

Rejected Claims

It often seems that health insurance companies automatically reject your claims. You think you’ve followed all the rules and you still get a bill in the mail stating you owe your doctor or hospital money. It’s frustrating and time consuming to battle an insurance company.

Hold On To All Paperwork

Sadly, many people shred paperwork after a few weeks. It can be months for a medical bill to arrive. By then, if you haven’t been vigilantly storing papers, you’ll have no proof that you should have been covered. Keep your medical bills, referral papers and insurance benefit guides in a file that is readily available.

Carefully Examine The Benefits

Before calling the health insurance company, read over their reason for denial and compare it to your benefits guide. Often, the guide is all you’ll need.

Set Things Straight Before A Surgery

Before a medical visit or surgery, contact the insurance company and ask exactly what is and isn’t covered. Find out if there are restrictions on who can assist during the surgery. If there is a specific lab that must be performing the lab work, take down the person’s first and last name, then add the date and time you called the company. Things that are often denied include x-ray or ultrasound tests that were performed by someone other than your doctor, blood tests drawn in a lab that is not part of the insurance policy’s provider list and seeking a specialist without a referral from your primary physician.

Contacting The Company

If your health insurance is through your employer, bring everything to the plan administrator and ask for help. Many times, your employer can help you battle the denial. You could simply have an out-of-date benefits guide and that can turn into a messy situation. If your benefits guide is out of date and you are certain you never received a new one, talk to your company. They may be required to pay the difference if it was their mistake. If this is not possible, either call or visit the insurer personally. A face-to-face visit makes it harder for them to deny anything.

Talk To A Supervisor

Don’t be afraid to ask for a supervisor for clarification. Many times, those answering the phones are under strict guidelines by the corporation. Talking to a supervisor helps eliminate any red tape. If you cannot get the response you want from the supervisor, you will need to file a grievance. A neutral party handles grievances and many times the neutral party will find in your favor.

Attorney generals and the BBB often send chills down corporation’s spines. If you enlist their help in resolving a matter, you often find that things will go in your favor. No company wants a hit on their rating and will quickly resolve an issue to prevent that from happening.

Related posts:

  1. What Is A Point Of Service Health Insurance Plan?
  2. Why Is Health Insurance So Important?
  3. How Does One Survive Without Health Insurance?
  4. What Is An IPA For Health Insurance?
  5. What Is Single-Payer Health Insurance?

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