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If your insurer refuses your claim, fight back and don't delay. Start by going straight to your benefits administrator at work. They may have the answers for you already. If this person does not exist at your place of employment or you have an individual policy, you might have to start with a phone call to customer service. Find out exactly why your claim was denied. If you are not satisfied with the answer, ask to speak to a supervisor. You may find that the claim was coded incorrectly, or the wrong information was submitted. You may have to put your appeal in writing. If this is the case, be sure you include all pertinent information and all requests made by the insurance company on what you should include. Be sure you document everything, including the times of calls and the names of the reps you spoke with, and what was said. Make several copies of the letter and other documents such as itemized bills you may need to include and keep a copy for your records and send a registered copy via US mail to the insurance company. You may also want to send copies to your state representative, the Department of Commerce, your State Health Department, and the Office of Consumer Affairs and of Your State Attorney General's Office.
Every plan has an appeals process that you must follow, some more complicated than others, but don't let that intimidate you. For more information, download the Kaiser Family Foundation's guide to resolving Health Plan Disputes at www.kff.org.
|Jennifer Mathes, Ph.D.|