There is no surprise to hearing massive complaints from patients stuck with their medical bills after insurers refuse to approve their claims. Every year the National Association of Insurance Commissioners (NAIC) collates a list of the most common complaints that usually stem from issues about the mishandling of claims.
Consumers are often guaranteed with tons of engaging benefits that they can avail from purchasing a policy. Very often, life insurance policies offer additional fund value and loyalty bonuses on top of the death benefit itself. With all these benefits, it is quite frustrating to learn that they won’t pay for your medical procedures because your claim gets denied for some reasons. If you find yourself in the same situation, you must feel very upset about being defrauded and treated unfairly.
Before you start picking a fight with your financial advisor or posting your anger on social media, try to collect yourself for a moment. As long as your mind is at peace, you should be capable of finding ways on how you can change your insurer’s decision.
At the end of this article, you will be able to identify the things that you can do to get your claims approved after being denied.
Step 1. Review your policy.
You are not the first person to encounter such inconvenience and you will not be the last one either. Instead of freaking out, why don’t you sit with your insurance documents and look over the summary of benefits that you are entitled to? There might be some parts that you could have missed out, which might as well help justify your queries. Besides the perks that you can avail, these documents must also define the exclusions of your coverage. For example, there are certain medical procedures/diagnoses that your policy will not cover.
Also, review the insurer’s statement for declining your claim. There should be a bona fide argumentation to why the claim was denied.
Step 2. Know your rights.
By reviewing your policy, you have understood the details that are covered or excluded from your chosen policy. Your documents should also mention your rights as a policy consumer: the right to know the process of filing a claim and the turn-around-time (TAT) for submission of requirements and the right to appeal the decision.
Step 3. Seek help.
If you are not appeased with the details mentioned from your policy documents, you can always ask for help. Call your insurer’s provider if you have further queries. If the reason for declining your claim is because of a billing error or coding of misinformation, call your attending physician’s staff to fix the issue and resend the filled-out forms to your insurance provider.
Step 4. File an appeal.
In case the insurer refuses to change their decision after fixing the misinformation, you can take your complaint to the next level. Follow your plan’s detailed instructions on how to file an appeal. You can also contact the insurer’s customer service to ask the representative if they can walk you through the process or send you a description of how to make an appeal.
You can also take advantage of the state insurance regulator to help move the process forward to the court. However, this step should be your last resort because taking your complaint to the court may cause a serious delay on your needed funds to pay the medical bills.
Step 5. Don’t let the same problem happen again.
You are less likely to encounter this inconvenience again in the future if you review your policy before and after undergoing a medical procedure. It is also important to follow the rules of your plan when it comes to filling up and submitting the necessary forms. Double-check the information to avoid errors and rejections of claims.