Debt Management > Medical Insurance Claims |
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What if Your Medical Insurance Claim is Rejected? Since an insurance companies' main goal is to maximize profits and minimize expenses as much as possible, they routinely reject or underpay medical claims submitted to them. Most people just give up rather than fight the insurance company; however, you might be able to get the decision reversed by following just a few simple steps. First of all, the initial rejection of your claim might not be personal. The insurance company might have sent you a form letter sent to all claimants who want reimbursement for a particular procedure or drug that they have pre-determined will be rejected. When this happens, you need to get confirmation from your doctor that the procedure or drug you need is medically necessary and critical to your health, rather than just beneficial. Ask your doctor to write a letter of medical necessity about the treatment or drug in question for you to submit to the insurance company. You can also do some research over the Internet to find out if the drug or procedure your doctor wants you to have follows basic guidelines endorsed by major medical organizations such as the American Heart Association. For example, at a medical website, one could type "standard guidelines" in the search box to find out what guidelines have been set for doctors treating patients with your particular medical condition. If you find out from your doctor or the Internet that the procedure / drug is medically necessary, file a former appeal with the insurance company by sending them a letter wherein you use the word "appeal". Send any supporting documentation along with the letter and send all of it certified mail, keeping a copy of the letter and your original documentation. The insurance company is required by law to process your appeal in a timely manner. If your insurance is provided through your employer, send a copy of your appeal to the person in charge of Human Resources or the Health Benefits Administrator. If they are looking out for their employees as they should be, they will put added pressure on the insurance company to reverse their original decision. Don't be afraid to contact the reviewers handling your appeal. A reviewer ight be a nurse or medical director or other person who works in the healthcare industry. What happens next? Statistically, if your appeal is heard by a panel of outside reviewers, there is slightly more than a 50% chance the decision will be reversed and the drug or procedure in question will be covered. |
Debt Kit -- Settle unsecured debts for less than half of amount owed Credit Kit -- Improve your credit rating and reduce monthly payments by $200+ |
Debt Management > Medical Insurance Claims |
