Americans rely on their health insurance policies to cover needed procedures and medications. Without coverage, the cost of getting the care that you need can be tremendous. As a result, many people panic when they find out that a health insurance claim was rejected. What steps do you need to take in the aftermath?
Check Your Explanation of Benefits
Your health insurance plan should provide you with a written explanation of benefits or EOB once the health insurance claim has been filed. This document will show you the amount of the procedure that the company is going to cover and the amount that you are expected to pay. If you have your claim denied outright, this document will tell you why. Some of the most common reasons are that you haven’t met your deductible include going to an out-of-network provider and not meeting your deductible.
Check Your Insurance Policy
Familiarize yourself with your insurance policy, even if you think that you know what it said. Which procedures are covered? Are there any common procedures that are not covered? Does your insurance require pre-approval or other special conditions to be met before covering a specific procedure? Understanding your policy’s terms will empower you during the appeals process.
Talk to Your Insurance Company
Next, you should consider reaching out to your health insurance company about your health insurance claim. Sometimes denials occur due to administrative errors or misunderstandings. An ordinary typo could lead to a claim being denied. When you call, make sure that you have your policy number and the denial notification on hand. Ask for clarification about the denial reason and about any steps necessary for an appeal.
File an Appeal
Most insurance companies have some sort of internal appeals process. Make sure that you file your appeal promptly, adhering to the deadlines specified in your policy. Provide all required documentation and information. During this process, keep records of all communications, including names, dates, as well as details of the conversations. If the insurance company doesn’t reach back out to you about your health insurance claim appeal, you should reach back out again. Most companies process claims for treatment that has been received within 60 days.
Don’t Stop at an Internal Review
If your internal appeal is unsuccessful, don’t give up. Many companies offer external review programs. An external review involves an independent third party assessing your case. If a denial is based on medical necessity, for example, this external perspective can often sway the decision in your favor.
MedHelp Inc. Is Here To Help
MedHelp, Inc. Uncommon Transparency. Uncompromising Service.
Call MedHelp, Inc. today at 443 524-4457 or toll-free at 1-800-275-6011 and let our team assist you in choosing the right solution. www.medhelpinc.com.
Also, you can follow us on Facebook.