As a caregiver you must be adept at dealing with insurance issues.
Especially in today’s complicated world of HMO’s, PPO’s and long
term care policies. The language alone is enough to send you packing. What
happens if your insurer refuses to pay part, or all, of your bills? It is
not that uncommon.
What many people don’t realize is that they can appeal if their
insurer says no. And people who know their rights have an outstanding
chance of winning those appeals.
Let’s hope you never have to go through that. However, as they say,
“An ounce of prevention is worth a pound of cure.” The following are a
few suggestions on how to arm yourself should the need to appeal a refusal
of insurance payment arise.
1) Save everything! Don’t discard any insurance papers or any papers
pertaining to your treatment. Save receipts for all doctor’s visits and
all prescriptions. Save copies of referrals to specialists. When you are
speaking with any employee at the insurance company, write down their full
names, positions, extensions, and whatever they tell you to do. Keeping
all of these things in a portfolio in some kind of order can only help you
organize.
2) Make sure your appeal is airtight. Writing a letter stating your
position is your first step. A letter is documentation--a phone call is
not. Your letter should be detailed, yet concise. Include important
information like your claim number, group number and policy number. State
the reason for coverage denial then describe your illness and treatment.
Next, state why you believe that your insurers made the wrong decision and
then offer a solution. Close by saying what you would like your insurers
to do. Your primary care physician and any specialists involved should
write letters as well(provided they are on your side).
3) Obtain your doctor’s full support. Your primary care physician
will most likely be anxious to stand by you through this ordeal. After
all, they prescribed a drug or recommended a procedure that your insurer
doesn’t want to pay for. In these cases, your doctor’s support is
vital to your appeal’s success.
So don’t take it lying down. You have certain rights as an insurance
consumer. A very small percentage of people ever appeal under these
circumstances, but it should happen more. It is probably easier for the
insurance company to just pay the claim rather than fight it.
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