How to Dispute a Health Insurance Claim

 

If you have never had a medical insurance dispute, and let’s hope for your sake you haven’t, you probably feel a little overwhelmed with what to do and where to start arguing your case.

 

It’s important to go about your disputed health insurance claim through the proper channels and in the proper order. You will want to start by contacting your employer’s benefits coordinator or even your human resource director to go over your situation. They may be able to nip your problem in the bud, saving you all kinds of stress and headaches. They might also be able to tell you right off the bat what you need to do. Or even better, they may contact your health insurance company on your behalf.

 

If your health insurance claim dispute is still unresolved after speaking to someone in your human resource department, then it’s time to consider an appeal.

 

First off, do you even have a case to appeal? There are a few things to consider. Besides you, your most powerful advocate is your doctor. If your health insurance company denies coverage for a procedure or medication, but your physician deems it imperative to your health, that’s important to bring to an appeals case.

 

Secondly, does your health insurance plan state that it covers the procedure or medication in question? Sometimes it’s simply a clerical error that brought on the denial, and one phone call to your insurer can save you time and money in legal fees.

 

Read the appeals process guidelines in your health insurance policy. And, make sure that you are aware of the time restrictions on the appeal process for health insurance claims. It will help you map out your strategy when you know the time period in which you have to implement your plan of attack.

 

Your next step is to put your complaint in writing. Documentation is always important, especially if you have to take the final step in the process - legal action. You should include the following in your written correspondence with your health insurance company:

If needed, contact your state’s Department of Insurance (DOI). They can provide you a wealth of valuable information, including your health insurance rights, and the process of appealing health insurance claims.

 

The last resort is legal action. Hiring a health insurance claims attorney to fight the battle on your behalf can be costly. You need to figure out what costs will be involved with a medical procedure if you have to finance it yourself. If when you compare the medical costs with the legal costs don’t waste your time or money just creating a headache and stress that you don’t need. Contact a health insurance claims attorney to get their expert advice on the matter.

 

But your health takes priority over any legal squabbles. Don’t delay a treatment if your long-term health is at risk. Your life is worth more than a temporary hardship