Ellen PhillipsI’ve just received an almost $1,000 bill from a health provider that, between Medicare and my secondary insurance plan, should have been covered. I can’t seem to get anyone explain why my claim was denied. Can you help?
– Paul Patient
Dear Mr. Patient: According to Bottom Line Health, over 200 million claims are denied each year. Sometimes the problem lies with doctors’ and hospitals’ failure to complete claims and/or errors made by the insurance companies themselves. But these days more and more are denied because the companies (or Medicare) believe the treatment isn’t necessary or is considered to be experimental. Either way, you’re the big loser. So what can you do to reverse their decision?
• Read your policy. I feel confident enough to bet $5 million – if I had it – that most folks never read their policies to see what’s covered. (In fact, if I didn’t need to be on the top couple of rungs of the consumer advice ladder, our family’s policies likely would go straight from the mail carrier into the fireproof box my husband and I maintain for such purposes.) With that said, you obviously can’t do a whole lot to rectify the issue if your policy spells out what it will or won’t cover. However, don’t stop there. Because insurance companies are notorious for altering coverage at any time it wishes, be sure to call and get pre-approval for any invasive or extensive/new procedure. As always, get the full name of the person with whom you speak and any other helpful, identifying information, such as the agent’s location and contract number.
• Be the upfront guy or gal. Don’t depend upon the medical provider to fix the problem for you; call the insurance company yourself. And as I always urge, keep a record of any type of “transaction;” in this instance, calls and correspondence with docs, hospitals, labs, and any other insurer that’s related to the denied claim becomes the backbone of a future appeal, whether it’s to Medicare or to a private insurance company.