Problem Solver with the Chicago Tribune covered a problem many people face and is often an issue lamented in the health care debate. When working with a broker, such as Barham Benefit Group, step-by-step assistance is given and handled by the broker for minimal hassle for the clients. These tips explains how to handle a denied health insurance claim on your own.
Few things are more disheartening -- or often terrifying -- than having a medical claim denied by your health insurance provider.
Every week, the Problem Solver is inundated with e-mails from readers fraught with tales of health insurance woe. In some cases, an insurance claim denial can lead to financial ruin.
To help navigate the confusing world of health insurance claims, the Problem Solver has compiled a list of tips on how to appeal a denied health insurance claim.
Before filing an appeal, make sure you have all of your paperwork in order. Read your policy carefully, and make copies of any documents that might help you argue your case, such as the pertinent medical files. It is essential you can prove that your treatment qualifies for coverage under your health insurance plan.
When you speak to a customer service agent from your insurance company, take detailed notes. Ask for documentation to support their denial, and talk with your doctor or doctor’s office for advice on how to refute it.
If your insurance policy is employer-sponsored, federal law gives you 180 days from receipt of the denial notice to file an appeal.
You can call the number on the back of your insurance card for help in filing your appeal, or find the address for your insurance company online. When filing, make sure to include:
* The patient’s name and identification number
* The date or dates of medical service
* The doctor’s name and a bill for the services in question
* Copies of related medical records
* A detailed letter describing why you think the claim should be paid
* Copies of your policy highlighting any passages that support your appeal
If your appeal is denied, most insurance companies allow you to appeal again.
If the claim is again denied, you still have options. If your plan is self-funded, meaning it is administered by an insurance company based on rules set forth by your employer, you can ask your company’s benefits coordinator to consider your case. The Problem Solver did this with a denied claim several years ago and got the claim paid.
Under a recently passed state law, Illinois residents will soon also be able to request an external review of denied claims. The law, signed Jan. 5 by Gov. Pat Quinn, goes into effect July 1.
The external review is paid for by the insurer and is completed by an independent review organization. The review is available if you have exhausted the insurance company’s appeal process.
The law requires you to request the review within 120 days of the appeal denial.
For more information on the external review process, visit the Illinois Department of Insurance on the web, at insurance.illinois.gov.
Chicago Tribune Problem Solver Blog