My health insurance company denied my claim. Is there anything I can do?
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Asked July 27, 2010
The first thing you need to do is find out why the claim was denied. Compare that reason with your policy to determine whether it was canceled under a legitimate clause or whether some sort of mistake is hampering the claim. It could be that the claim was denied because of missing or incorrect paperwork or even a late filing by your primary physician.
Make sure that you can document the treatment and why it was necessary. Your primary physician should be able to help you with that by supplying copies of your referral to any specialists or other prescribed treatment. If the claim is denied because of a preexisting condition, can you show that you did not suffer from the condition?
Can you demonstrate how the treatment has made you less of a health risk or reduced other health care burdens? If you can demonstrate to the insurance company that the treatment is actually going to save money in the long run, they will be more likely to reverse the decision and pay the claim.
If all else fails, you may have to contact an attorney. This is not a good way to establish a relationship with your insurance company, and involving your lawyer should be used only as last recourse for a legitimate claim that has been denied. It is also important to remember that the cost of legal fees and a court battle can be very expensive, and you must weigh the risk of losing the battle against the claim itself to decide whether such actions are economically feasible.
Answered July 27, 2010 by Anonymous