Health Care
Is A
Human Right
Is A
Human Right
Some Actions You Can Take If Your Health Insurance Claim Has Been Rejected
Printer-friendly version
1. Ask for a full copy of your policy if you were not given one when you first signed up or cannot locate it. They will probably tell you it doesn’t exist. If so, get as much as you can. They might give you what they call a “certificate”.
2. When on the phone with your insurer, take copious notes and take the names and direct phone numbers of everyone to whom you speak.
3. Pay attention to the provider codes. If a code is wrong, correcting it might solve your problem.
4. Ask them to tell you why the claim has been denied in writing. They may require you to write to them first.
5. If you feel they are handling your claim in “bad faith” tell them so.
6. When you get your denial in writing, look through the policy and see if you have a basis for appeal.
7. Ask the insurer what their appeal procedure is and follow it. They usually want a letter explaining the basis of your appeal.
8. If your appeal is denied, or you need help deciphering the companies responses you can:
a. Contact the Office of Consumer Health Insurance of the Illinois Department of Insurance
i. By phone (877) 527-9431
iii. by fax to (217) 558-2083, or
iv. by mail to 320 W. Washington Street, Springfield, IL 62767 OR
b. Call the Attorney General’s Office at 877-305-5145, or file an AG complaint at: http://www.illinoisattorneygeneral.gov/consumers/healthcare.html
Common complaints handled by the Attorney General’s office include:
§ Denial of insurance benefits because prescription or treatment is considered any of the following: Not medically necessary, experimental or investigational, cosmetic, preexisting condition, not used according to FDA approved guidelines.
§ Slow pay on claims that may or may not result in damage to the consumer's credit history.
§ Claims partially paid leaving the consumer with an unexpected large balance to pay.
§ Denials of coverage for emergency services including emergency ambulance services.
§ Difficulty with access to primary or specialty physicians.
§ Billing disputes take many forms, such as fraudulent billing schemes and gross overcharging.
§ False or misleading advertising relating to health care issues.
§ Various problems involving the in-network versus out-of-network referral processes.
§ Difficulty with negotiating the internal or external appeals processes once a denial is issued.
Bookmark/Search this post with:
- Steve S's blog
- Login or register to post comments
- Printer-friendly version
- Send to friend
