In my opinion and after a reading a recent CNN article, here are 6 ways to deal with an insurance company’s denial of your claim:
1. Get help – enlist the help of you health care professional, the patient advocate, hospital benefits office and your employee benefits coordinator. All can be more influential and exert more influence than you.
2. Be persistent – Do no stop with the first denial. Insurance companies hope that you will not appeal their decision. The longer it takes for you to obtain your benefits, the more money that have your money, and make interest on it. Actually, the social security disability system is set up so that you have to appeal their decision at least twice before your claim is taken seriously.
3. Justify your claim – The claim must arise from a medical necessity. Any suspicion the treatment is for a non-medical necessity will raise red flags and certainly lead to a denial. A pre-existing condition or bringing a claim for cosmetic reasons will justify the insurance companies denial. A pre-existing condition will also raise suspicion. According to the CNN article, TMJ can be re-characterized as a disorder affecting chewing food, or a biting disorder. This allows the condition to fall within the benefits plan.
4. Re-enlist your health care provider and obtain their assistance. Having a doctor re-submit a claim using a different diagnosis or using different diagnostic coding allows the claim to be paid. If your doctor or health care provider can justify the re-submission the insurance company may be forced to pay for it.
5. Getting the help of an attorney. Often, I tell those in need of assistance to put my name on the bottom of the letter, or in the vernacular, cc me on your letter. Having Edward C. Harper, Esq. often works as an encouragement to the insurance company. As a result of an attorney’s name on the bottom of the letter, the insurance company will know you have an advocate in your corner.
6. Finally, retaining the services of a lawyer can assist in structuring the appeal correctly. Denying benefits is one of the ways an insurance company makes money. So having an advocate ready to go to bat for you will provide you with some peace of mind during a difficult time. An attorney may be necessary to evaluate the insurance policy and in interpreting the medical records so the claim is presented properly.
If you have any questions or concerns in regards to an insurance claim, call Harper Law PLLC at 425 284 3333 or toll free 877 780 2800 or e-mail me ated@edharperlaw.com.
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