How to Get Help With a Health Insurance Issue
- 1). Contact the health insurance broker who helped you purchase your individual health insurance policy. These brokers are generally quite knowledgeable about the ins and outs of filing a claim, and they can be very helpful when issues arise.
- 2). Contact the Human Resources department at your company if you receive your health insurance through your employer. Many companies have an individual who is in charge of resolving disputes with the insurance company, and that individual will generally have in depth knowledge of the insurance company and how it pays its claims.
- 3). Review your health insurance policy carefully, especially the sections covering exclusions, deductibles and co-payments. It is important to understand your coverage before filing your appeal.
- 4). Review your explanation of benefits (EOB) statements carefully to understand the nature of the claim denial and the reasons for it. Be sure to provide this information to your health insurance broker, Human Resources representative or attorney.
- 5). Contact the customer service department at your health insurance company by calling the toll-free number listed on the card. Ask the agent how to file a formal appeal of the denial decision. Many insurers make these forms available on their websites, while others require policyholders to submit a written form. No matter what the process, be sure to provide complete and accurate information when filing the appeal. Have your EOB form and denial letter handy--you will need these to fill out the appeal accurately.
- 6). Contact your medical provider for assistance as well. The staff at your doctor's office, or the insurance billing department at the hospital, can be very helpful when working with insurance companies. Unlike ordinary consumers, individuals working in the health care arena are use to working with insurance companies. The office manager at your doctor's office may be able to spot an obvious mistake on the original form and help you with resubmitting the claim or filing a formal appeal.
- 7). Consult with an attorney if there is a great deal of money involved. If the claim in question is only a few hundred dollars it may not be worth it to hire an attorney. But if thousands of dollars are at stake an attorney can be a great help. The National Association of Insurance Commissioners website, www.naic.org, is a good place to start the search
- 8). Contact your state's insurance commissioner for assistance as well. Each state has a body that is responsible for overseeing insurers doing business in that state. These agencies can be very helpful when consumers have problems or complaints.
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