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When Your Insurance Claim is Denied

Your insurance policy or managed care contract will spell out procedures for filing complaints or grievances.  But the scales are tipped in favor of the company.  If you're having problems, contact your state Insurance Commissioner to file a complaint.
At times, insurers refuse to pay for treatment they deem medically unnecessary or those considered experimental.  If you are in a managed care plan, they not only can refuse payment, but refuse to provide the treatment.
Here are suggestions for fighting back:

  • Keep copies of all your bills.  Check for errors.
  • Ask your doctor to support your position.  He can explain if there were special circumstances or why the charges were more than the insurer considers customary.  (If your insurer claims your doctor is ``overcharging,'' don't assume the accusation is true; the insurer might be guilty of underpaying.)
  • Find out your plan's definitions of ``medical necessity'' and ``experimental.''  Your doctor can provide evidence to explain why the treatment was necessary and/or not experimental.
  • If your claim is denied as a pre-existing condition, ask your doctor for documentation that it developed after your coverage began.
  • Keep notes from all phone conversations and keep copies of all correspondence.

DPMA in the News!

August 1st, 2012

Written by Loren Heal

Physicians reacted with shock and anger to the Supreme Court’s decision to uphold the President Obama’s health care law, according to poll data and the leaders of activist groups, which are continuing to fight the law in court and via political action.

According to Kathryn Serkes, cofounder of the Doctor Patient Medical Association, a recent nationwide poll sponsored by her organization found 83 percent of U.S. physicians have considered leaving their practices due to President Obama’s law.

“This not just something that started today, and it’s not something that just started with passage” of Obama’s law, said Serkes. “There have been developments in medicine that have made it very, very difficult and have put some seriously different pressures on doctors. But this bill has certainly brought things to a head.”

Read the full article here...


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