Your health insurance claim was denied. Now what?

| Oct 12, 2016 | ERISA Disability Benefits

No one really wants to purchase health insurance or accidental death and dismemberment coverage, whether at work or on the individual market. You buy it because it will provide the protection you need when you or a loved one need it.

Unfortunately, your insurer is more likely to see you as a profit driver rather than someone who is buying a product to avoid accumulating a disastrous amount of debt if a medical emergency occurs.

Insurance companies often make policyholders jump through all kinds of hoops to actually have their claims honored. The process can be confusing, intimidating and extremely frustrating, especially when your insurer keeps denying your claim for seemingly no reason.

Remember that you have options

The National Association of Insurance Commissioners, which is an organization made up of state insurance regulators, reminds consumers to “be persistent” and to not take no for an answer. The Affordable Care Act and Employee Retirement Income Security Act provide crucial protections for policy holders.

Additionally, you should:

  • Read through your policy carefully. Federal law requires health insurance plans to spell out their coverage in plain language. It should also state how you can appeal a denied claim.
  • Keep track of all correspondence with your insurance company. Hold on to denial letters and make copies of any forms that you send to the insurance company. Sometimes a denial can be caused by a simple paperwork error, either on your end or by an insurance company employee. If you speak directly with an insurance company representative, keep good notes.
  • Gather all of your medical records related to your claim. It will be important to follow your doctor’s recommended course of treatment. Also, keep records of everything, such as x-rays, lab test results and prescriptions that you can present to show the extent of your condition.
  • Consider contacting an attorney. In some cases, it will be necessary to hire an attorney who has a deep understanding of the law and how to keep your appeal moving forward. Insurance companies have strict timelines that they must adhere to when determining how to proceed with your claim. A lawyer who knows how to hold these companies accountable may be who you need in your corner to get a positive result.

Whether you have a private health insurance plan or you have work-provided coverage, a lawyer may be able to help you get the coverage you need. There is no doubt that this will be a frustrating process, but by working with an experienced attorney, you may be able to get peace of mind.