by Michael Burman
Health insurance companies often deny pre-authorization requests for testing or medical treatment. Sometimes, the company refuses to pay the medical bill after you have already received the services. You feel punched in the gut when you receive a bill, sometimes for hundreds of dollars, with a note from the care provider that your insurance denied your claim.
Many times, the denial seems unfair. You may feel trapped and assume there is nothing you can do, but if this has happened to you, you do have some options. You can appeal the denial, but the first step is to understand why the claim was denied.
Now, We Need to Learn Some Insurance Terms. I realize the following terms are unfamiliar to you. Refer back to these insurance terms as you study this article.
Call your insurance company. Have them explain to you in detail why your claim was denied. Also, ask them to explain to you how to file an appeal. Follow the appeal instructions precisely.
Write an appeal letter. This is the most important part of your appeal. The purpose is to convince the company that it should pay your claim. Your letter should include:
Be sure you keep a file documenting everything you have done. Any time you have a conversation with an insurance representative, document the date and time of the call, who you spoke with, and a summary of your conversation. If you are told to call back because the person you need to talk to is away, note the date and time of your call and the reason you were given to call back.
If your internal appeal is denied, you can then contact your state's insurance commissioner and request an external appeal. The National Association of Insurance Commissioners maintains a list of all state commissioners and information about how to contact them.
Depending on the amount of money involved, you may decide to do this appeal yourself. If a large amount of money is involved, or you just feel you need help with the process, contact us at Burman Law. Our slogan is “Mike Will Fight to Make it Right.”
Mike is a death and injury lawyer with 25+ years of experience helping hundreds of accident victims against at-fault drivers and commercial operators of all types. Other lawyers often call Mike for advice with their personal injury lawsuits and wrongful death lawsuits. Once you begin your free case evaluation with Mike, you will know the legal advice is coming from an experienced attorney who knows the law and wants to help you overcome a difficult situation in your life.