Fighting Health Insurance Claim Denials

Usually, you need not to fight against your insurance company for settlement of your claims. However, there may be some incidents when an insurer has to fight for his claim when company denies to making payments of such claims. Though the feasibility is rare, you must know the ways to fight such denials.

The best way to avoid fight against claim denials is to follow certain steps. If it doesn’t work then you can take following steps:

• First understand the coverage provided by your plan. Maintain a record of your interactions with every individual involved in the process and keep all paperwork in order.
• Obtain all the information you can gather which will support your claim. Knowledge of the policy is considered to be major factor that can lead to your win.
• You must understand the various provisions of your insurance policy. Special attention should be paid to limitations and exclusions. You should know what is covered and what is not covered under your health insurance plan.
• Inform your physician about the aspect of ‘covered' and ‘not covered’ whenever you acquire medical care from him.
• Follow the laid down rules like obtaining prior sanction, wherever necessary. Never obtain a non covered treatment assuming that the insurance company will approve it at later stage. This aspect has been the cause of many denials.
• Maintain a written record of every activity concerning your health insurance policy such as date of obtaining treatment, from whom you obtained the treatment, what the provider recommended etc.
• Preserve copies of all prescriptions and other papers, in chronological order, that are issued by your physician and documents that you receive from insurance company.
• If your physician is not affiliated to the plan provider, your must inform him that your insurance company will make the payments, before you obtain medical care.

If your claim is denied even after observing these precautions, you must ask your insurance company to furnish the causes for denial or delay. If the claim is denied on the grounds of higher cost, you can ask your physician to provide item-wise expenditure details and submit it to the insurance company. If your company does not respond or admit the claim even after this you can request for a review to the insurance company

If the problem persists, you have the option to approach insurance department of your state. Different states in U.S. have different rules for dealing with appeals concerning denial of health insurance claims.