Health Insurance Hassles?

The health insurance and HMO (Health Maintenance Organization) system can be daunting. Often times, the treatment recommended by your doctor is denied coverage by your plan. Is there anything you can do about it?

Absolutely.

Many insurance companies deny initial claims as a matter of course. Become familiar with your company's appeal process by:

  • Getting a copy of your policy and reading it thoroughly. If your policy doesn't outline the procedures for appeal, request a copy immediately.
  • Reviewing the instructions for appeal. Make note of deadlines and special exceptions - one of these exceptions may be yours. Copy down any language that you believe applies to you.
  • Making a call. With all of your information in hand, call your insurance company. If your claim was denied routinely, you may be able to reverse the denial with a couple of phone calls. Always write down the date and time of your calls and the names of the people you speak to.
  • Still no luck? Write your insurance company a letter that includes:
    • Your name, your group number/ social security number and the name of the insured person.
    • The procedure that was recommended and why it is necessary.
    • The reasons your insurance company gave for denying the claim and the date of the letter or phone call in which your claim was denied.
    • The reasons you believe the procedure should be covered. Include any information or helpful language that you found in your policy.

If your appeal is denied and you believe that you have a right to coverage, don't give up. Contact you're the insurance commissioner in your state to ensure that your insurance company is treating you fairly. The following online resources can get you started: