When you find that your medical bill is being denied there are certain steps you can take to help fix the dispute and get your bill paid. Many times there are solutions to the problem but it is your responsibility to see into the matter. You should read the reason that you are being refused to find out what is needed in order to get approval. Then you should find your policy and or documentation that explains what is covered and what is not covered in your policy. Then go to the exclusion section and read it very carefully. I would highlight any exclusion that might even remotely refer to your exclusion reason. Make sure that you have all claim denials, invoices, documentations, and notes that reference your claim.
You now are ready to call up the customer service division of your health insurance provider with all the facts in hand. You should state clearly the reason you are calling and ask them for a representative who can help settle claim disputes. Make sure that you document all calls making notes on what is said letting them know that you feel your claim should be paid. Often times one small reason for your claim denial maybe over turned by the fact that other things that are stated in your policy. When you are done with your conversation with the representative makes sure that you get a date by which your claim will be resolved. This is very important as you don’t want the claim to continue interfering with your medical care and your credit.
When your claim is paid you should always check to make sure that the amount paid agrees with the terms of your plan. Your coverage might call for the insurance provider to pay 60% and they only pay 40%. You need to make sure that whatever part they are held accountable for is covered. Then you are held accountable for the balance of your bill. Dealing with insurance representatives can be a very difficult experience and you need to stand your ground explaining why you are covered. Do not let them discourage you from your goal. That is their job to save for the insurance company but your job is to get your medical bills covered so you can keep getting the health care that you need. You may find in the end that you are fighting a losing battle do not get discouraged. You do have the option of speaking to your physician about the matter and having them call the insurance company on your behalf. You might be surprised often times a call from your physician can get the claim settled immediately. This is of course your last recourse and I would not advise you to go this route unless it is absolutely necessary.
Depending on how large your medical bill is, this will all determine how the long the process is going to take. Remember, it’s going to take time. Take your time and your progress will slowly pay off.
Resource: http://www.isnare.com/?aid=331607&ca=Finances
