As a caregiver you must be adept at dealing with insurance issues.
Especially in todayís complicated world of HMOís, PPOís and long
term care policies. The language alone is enough to send you packing. What
happens if your insurer refuses to pay part, or all, of your bills? It is
not that uncommon.
What many people donít realize is that they can appeal if their
insurer says no. And people who know their rights have an outstanding
chance of winning those appeals.
Letís hope you never have to go through that. However, as they say,
ďAn ounce of prevention is worth a pound of cure.Ē The following are a
few suggestions on how to arm yourself should the need to appeal a refusal
of insurance payment arise.
1) Save everything! Donít discard any insurance papers or any papers
pertaining to your treatment. Save receipts for all doctorís visits and
all prescriptions. Save copies of referrals to specialists. When you are
speaking with any employee at the insurance company, write down their full
names, positions, extensions, and whatever they tell you to do. Keeping
all of these things in a portfolio in some kind of order can only help you
2) Make sure your appeal is airtight. Writing a letter stating your
position is your first step. A letter is documentation--a phone call is
not. Your letter should be detailed, yet concise. Include important
information like your claim number, group number and policy number. State
the reason for coverage denial then describe your illness and treatment.
Next, state why you believe that your insurers made the wrong decision and
then offer a solution. Close by saying what you would like your insurers
to do. Your primary care physician and any specialists involved should
write letters as well(provided they are on your side).
3) Obtain your doctorís full support. Your primary care physician
will most likely be anxious to stand by you through this ordeal. After
all, they prescribed a drug or recommended a procedure that your insurer
doesnít want to pay for. In these cases, your doctorís support is
vital to your appealís success.
So donít take it lying down. You have certain rights as an insurance
consumer. A very small percentage of people ever appeal under these
circumstances, but it should happen more. It is probably easier for the
insurance company to just pay the claim rather than fight it.
to our weekly e-newsletter