There’s nothing worse than being sick, except for when you’re sick and dealing with insurance issues. Denials can occur before you’ve gotten a test, treatment, or procedure or after you’ve already received the care. Often then, the insurer may argue that the service is not covered or not medically necessary for you, or it may deny care on logistical grounds like having incorrect information coming from an out-of-network provider. There are a few steps you can take to fight back.
- Read Your Denial Letter in Full: It is easy to skim over a letter that is full of medical jargon but it is important to read it in full. It could be as simple as re-submitting a claim with different information or it could require putting together an appeal to argue that your doctor’s treatment plan is, in fact, medically necessary. Also, insurance companies make mistakes “all the time” so it is important not to assume your denial letter is completely correct and give up right away. Consult your policy documents to verify what the insurer is claiming is true and ask them to correct any errors you find.
- Appeal: If your denials can’t be easily reversed, there are still other options like an appeal. Filing an appeal does require some work. First, you have to refer back to your denial letter about how to file for an appeal and any specific instructions. Your goal is to make a clear and compelling case why this need for a treatment, procedure, or medication is necessary. If possible, getting your doctor involved can help and can strengthen your case.
- Escalate: If your appeal is denied, that is still not the end of the road. You can request an external review in which a third party then assesses the case.
- Get Help: If this begins to become all too overwhelming, call in the experts. Health advocates can help put together a strong appeal for you as they understand the ins and outs of the system and what’s worked with specific insurers in the past.
Whatever route you take to overcome the issue, it is important to remember that there are people who can help. Talk to an insurance agent today to make sure that your insurance covers all your medically necessary needs to avoid issues in the future.
To learn more about your insurance choices, connect with one of our agents today to discuss all your options and answer any questions you may have. The experts at LIG Solutions have licensed health insurance professionals intending to offer a simple and transparent view of healthcare coverage. There’s no need to spend hours trying to understand different plan options – we’ll work with you to understand your needs and budget to recommend a plan that will work the best for you. And because we have no vested interest in which insurance carrier you go through, you can rest easy knowing we are truly looking out for your employee’s best interests.
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