Health Insurance Claims Resolving a Dispute in your Favor can be Simple

A seasoned insurance company agent once told me it is customary, if not straight forward procedure to deny specific claims on healthcare because the average consumer wouldn’t waste time fighting for payment. The sad reality, most people don’t. Most people gripe and swear and end up tossing their check in the mail because they don’t want to take the time and effort to dispute a charge. Fighting wrongful fees can be frustrating, but worth the effort. Here are some suggestions.

First of all, read your policy thoroughly, fine print and all. Many times we call and scream and act self righteous only to find that our policy does in fact exclude that treatment or care. To save yourself wasted time and embarrassment, know what you are fighting.

Second, get all your paperwork together. Have your policy in front of you and highlight any pertinent information. Collect your doctors bills, and call their offices and labs to access what exactly the procedures were. Most bills are rather cryptic, but your doctor will have an itemized list of what was done. The more knowledgeable you are about your treatment, the more you insurance carrier will know you are well informed.

Third, call your agent. If you are given the run around, ask to speak with a supervisor. Be persistent. Document the name of the representative you spoke with, their id number, what time and date you called, and the specifics of your conversation. If you can recite that “Dana, id #36852 said such and such on this date at this time” they will have something to reference. They will not be able to use the excuse they have no record of your call.

If the supervisor isn’t able to help you, try and try again. In addition to phone calls, email (keep record of every email and response) and write your insurance carrier. If no one seems intent on helping you, schedule a meeting in their office. Generally, if you come equipped with your policy, your doctors itemized lists of treatment and a competent argument they will try to assist you.

If you get nowhere, contact your state’s department of insurance to file an appeal. If you are fighting over a large sum of money, consult an attorney. Once threatened with legal action, your insurance carrier will usually bend.

Claims disputes can be a time consuming and frustrating affair, but if you remain positive, informed, and polite, you will generally get much further than being ignorant, yelling or screaming into the phone. Follow protocol, and your dispute will generally be taken care of in time.