It is a scenario that is very common in the United States these days, but it is still incredibly shocking when a person that desperately needs medical assistance has their health insurance claim denied.
Despite knowing you need coverage for a condition which will severely impact your health and might even put your life at risk, someone sitting behind a desk deemed you unworthy for critically important care.
If this is a situation you find yourself in, what can you do next? As it turns out, there is plenty you can do to fight back against insurance companies that value their bottom line more than the customers they serve.
Once you have calmed down, begin the process of appealing this wrong-headed decision by following the steps outlined below.
Find out why they denied you
Before you can begin the appeals process, you need to figure out why your insurance company denied your claim in the first place.
Look into the protocol for appealing denied claims through your insurance provider, and take copious notes on the information that the representative provides you. You’ll need every bit of info they end up divulging, should you need to take further action.
Contrast the denial letter against the language in your plan
If your claim denial wasn’t an easily resolvable misunderstanding, you will need to request certain documents which will help you in your bid to win an appeal.
The rejection letter and documentation of your provider’s full list of coverage and benefits are key documents you should have at hand before making your case, as they contain evidence which will form the basis of your argument.
In particular, be sure to look for procedures which your insurance company deems as medically necessary. If they have denied your claim when you have a condition that falls under this category, you will have a rock-solid case that your denial of coverage was unjust.
Seek out professional assistance
If your carrier is being stubborn despite overwhelming evidence they are in the wrong, you will need to seek out legal representation.
In most cases, being denied by insurance means you will have a long fight ahead of you, as company representatives assume you won’t have the patience and stamina to see a legal challenge through to the end.
Not only will a personal injury lawyer be able to represent your interests professionally in court, but they may also be able to pick up on things you may not have noticed in the initial review of your policy, further strengthening your case.
Hang in there
Those with power and deep pockets count on you being demoralized by the insurance process as it currently stands. They want to give up and accept your fate while they count their profits.
What they don’t want you to know is that you have a very realistic chance of winning if you are willing to dig in your heels and fight for the rights to which you are entitled.
Take a deep breath, know that the truth is on your side, and work with smart legal professionals who will do everything in their power to ensure that you receive the benefits you so desperately need.