How to fight the insurance company on medical debt

Notice that the letter you got from the insurance company shows a denied medical claim. This must be a mistake. You have medical insurance coverage so why are my claims being denied? Many Americans are unaware of exactly what is covered in there medical plan. It is highly recommended to review your contract before accepting or switching your medical plan. There could be many items that are considered a covered procedure but also have limitations.

When a claim is either paid or denied you should receive an EOB. This is an explanations of benefits. They are usually sent through mail and/or available on your providers website. Each insurance company uses this EOB to describe the procedures done, cost per item, approved and non-allowed amounts. Some will even provide specific codes for each item.  When reviewing your EOB there are certain terms you must understand. If an appeal is needed that can not be done through you physicians office you must complete the appeal yourself . It is now your responsibility to take action to avoid underpayment or even fraud.

Explanation of benefits- A very specific document of  procedures performed. These are often a coding system which will require you to refer to other sections of the document. This will explain any co-insurances, deductibles , and denials.

Deductible- Amount you as a patient must pay to receive certain procedures. These are usually high cost procedures. A deductible can range from $100.00 to $10,000 or even higher. These plans are considered  high-deductible plans.

Co-insurance- After your deducible is met you might have a coinsurance. This is the amount you as a patient must pay after your deducible is met. You might have a 20% coinsurance .  This means after a procedure is approved for payment, a discount is usually applied to the service. This means, in most cases a physician cannot bill you as a patient the full amount he or she has billed to your company. This is also called an non-allowed amount.  If your plan has a zero coinsurance amount this means after you have paid your deducible services are paid at 100%.

Before you call your insurance company , investigate your claim denial yourself. Try to get at least some knowledge before calling a customer service representative.  Check denials codes of your EOB. This might answer your questions. If this is a more complex issue and you receive benefits from an employer, you should  meet with your benefit department before explaining to the customer service department. It is common for patients to call there insurance company and are connected to a person who has little training and can answer your questions completely wrong.