An internet survey recently conducted by PNC Financial Services Group found that out of 1,000 consumers, close to one in four said they had a legitimate claim denied by their health insurance. Here are some helpful hints when dealing with denied claims:
1. Get Help: Seek help from your doctor, hospital business office, and employee benefits office. These offices can be a lot more powerful then you. Also seek help from the Patient Advocate Foundation, a non profit group who employs case managers specifically to help people work out insurance company issues.
2. Be Persistent: Appeal, appeal, appeal. “You may go through three or four levels of appeals before you get a favorable resolution” says Nancy Davenport-Ennis, co-founder of the Patient Advocate Foundation.
3. Use the Right Words: According to advocacy groups, certain words like “cosmetic” or “to enhance esteem” can trigger the denial of medical bills. Insurance companies may refuse to pay these bills claiming the procedure was not medically necessary. Instead, use words that mention the specific problems.
4. Ask your Doctor to Resubmit: Sometimes just having your doctor tweak the paperwork slightly will fix the problem.
5. Seek Legal Help: The help of or the threat of using a lawyer is sometimes all the convincing an insurance company needs to start paying denied bills.
Mohit Ghose, a spokesperson for America’s Health Insurance Plans, which represents 1,300 insurance companies, stated that the survey was flawed. He asserts that only about 3-4 percent of all claims are denied by companies. He attributes these denials to doctors entering in the wrong codes when filing the insurance papers and employers not purchasing certain kinds of health care for their employees’ insurance.