How Do I Fight My Health Insurance Company Over a Claim?

By | February 13, 2012

Having an exorbitant amount of medical bills these days is not fun – between the high costs  of medical procedures and the difficulty of finding quality health insurance, it can be a nightmare for people who are already living paycheck-to-paycheck. But what’s worse is when you are indeed covered and your health insurance company still denies your claim.

If that’s what has happened do you, the only question on your mind is simple: how do you fight your health insurance company? While each case is different, there are a number of legal strategies at your disposal you can use in order to make sure that you get the coverage you’ve deserved all along.

Know Your Health Coverage

The first thing to do when you’re thinking about fighting your health insurance company over a claim is to check the existing coverage. You should have a copy of the agreement you signed somewhere in your files; if not, you can always request a copy directly from the health insurance company itself. Once you have this agreement in hand, be sure to give it a thorough reading in order to check for anything you might have missed the first time. Then, zero in on the sections that would relate directly to your current predicament.

If you signed an agreement that allows the health insurance company to deny you coverage on this current claim, there’s a good chance you won’t be able to do much about it. And you may notice that there may indeed be grounds to fight your health insurance company. Either way, you’ll want to make sure that your next steps are made on a solid legal foundation.

Strategies for Fighting a Denied Claim

The first thing to do if you notice a mistaken denial is to consult the health insurance company themselves – they might be able to correct the error over the phone. If not, you may need to escalate your fight, but make sure that you avoid a simple misunderstanding before you do this.

A formal written appeal is often the next step in fighting your health insurance company’s claim denial. You can often find information about this appeal process in your health insurance packet, showing that there was indeed a reason for all that paperwork! If not, you can try to contact the health insurance company directly to find out about the appeal process.

If your appeal goes to arbitration, that could mean a potential resolution for you – in most cases, a third party will offer a solution for both ends and it’s up to the two parties to determine whether or not they agree.

Along the way, it’s important that you keep a written account of everything that’s happening – from the phone calls to the written documents. The more you keep track of, the better you’ll be able to make a case against the health insurance company if you need to escalate to litigation.

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