Out of control insurance claims and medical expenses are hardly a secret these days. Currently, 57% of people facing home foreclosure say medical debt or other medical expenses are the cause. Out of this 57% only 10% felt that they were under-insured.
Eliminating medical debt is almost impossible to do. Though there are tools that you can use to fight back, should your claim be denied.
First, make sure the problem isn’t something simple, like an incorrect detail about your care. Examples would include things like the doctor’s name, date of service, etc.
Current statistics show that insurance companies make processing errors in as many as 14% of all claims. Hospital bills are processed having an even an even higher rate.
If you receive a notice that insurance claims have been denied, immediately check your bill. If you find no obvious errors, as already mentioned, check the explanation of benefits section. There you will find a code that provides the reason that you were denied.
Whatever the reason, don’t delay; you only have 180 days after the denial to file an appeal!
Next, get a copy of your summary plan description (SPD) or certificate of coverage. Then collect all of the medical records that involve your case.
You’ll need these things to send an appeal letter to the insurance company. Use a sample letter to write an appeal that is precise and specific. You can find these sample letters at both Healthlawadvocates.org and patientadvocate.org
When mailing your appeal letter, be sure to use Certified Mail. If you can afford it, get a return receipt also. By doing this you’ll have proof that it was received and who received it.
Please remember that the address for appeals is probably different than the regular mailing address.
If your appeal isn’t successful, you still have 60 days to have your insurance claims reviewed by an independent board. This board is run by either your state government or in some cases the Federal government.
Remember, if you need any kind of help with insurance, MrInsurability is here for you!