Ways to Appeal for a Rejected Insurance Claim

When a person can actually save money, for medical care which he anyway thought he was covered for, some patient follow up with a calm and confident demeanor can actually turn things in his favor.

When an insurance claim is rejected it is best to stay calm and research the reason of the rejection, though this may require a lot of patience, you have a 50% chance of saving thousands of dollars in medical bills. First of all research why your claim was rejected and ask for an explanation, keeping records of when and whom you spoke to. "Take down notes and get the language down as cleanly as possible," said Stephen Parente, a professor of health finance and insurance at the University of Minnesota. Learn the entire appeal process along with deadlines as a missed deadline can negate your appeal.

At times the cause for rejection can be something as simple as a clerical error, like a wrong code being used for your medical procedure. This can be clarified with a few calls to your health providers billing office.

Fraudulent Health Insurance Claims
To educate the public regarding hazards of committing fraud in healthcare insurance claims and its implication on the economy.

Write a letter with all the points clearly highlighted as to why your claim should have been honored. Your doctor can offer his input on this. A physician can attest as to why the care you needed was medically necessary and all other alternatives had been exhausted. Support the doctor’s theory with all medical records – even confidential ones. Try to include articles from medical journals which will add support to your claim. You can use the National Institutes of Health website www.pubmed.gov to search journals around the world.

The insurer’s reasons for denying your claim have to be directly addressed – this is important. All correspondence should be sent by certified mail so that you can document the dates and deadlines which can prove or lose your claim. Do not give up, be persistent. The insurer may allow a peer-to-peer review in which your doctor can meet the physician appointed by the insurer.

Some people with employer sponsored health insurance can ask the company for help. Large companies with more than 200 workers usually pay the medical bills and insurers are hired to manage their plans. When the employer refuses to overturn the insurer's decision, it is important for companies to be brought into the appeals conversation so they can consider making coverage adjustments over time.

Key Procedures for Filing a Healthcare Insurance Claims
keep yourself well informed about the claim process and avoid frustration of your claim getting refused.

The human resources department can check to see if your coverage is self-funded help you understand the procedure for an appeal. Some states offer consumer assistance programs, and your insurer should provide you with contact information for the program in your state. Help is also available from nonprofit agencies like Patient Advocate Foundation and The Jennifer Jaff Center, which can assist with appeals in cases involving chronic, life-threatening or debilitating illnesses.

References:

Top Up on Health Insurance is an Advantage
The need for the top up plan and super top up plan arises due to the high cost of medical treatment and hospitalization.

Tom Murphy, August 2014

Hannah Punitha (IRDA Licence Number: 2710062)

The Impasse With Employer-Sponsored Health Insurance
The moot point is that – are the people of America happier with individual health insurance rather than the traditional employer sponsored health insurance?

Source-Medindia