Appealing A Health Insurance Denial

Posted by & filed under Personal Injury.

Sometimes, the stable feeling you have when you are on health insurance can unexpectedly be interrupted and bring you a significant amount of undue physical and emotional stress. For example, it is often upsetting to receive a letter in the mail notifying you that your request for medical care, or a claim for reimbursement for care, is denied by your health insurance company. Fortunately, there are a series of steps you can take to help you be more successful in obtaining an insurance claims appeal.

 Prevent Denial of Health Insurance Claims

Health insurance policies and procedures are often confusing, especially when enrolling in healthcare through the state or at the start of a new job. It’s important to know the intricacies of your health insurance policy prior to seeking care. Some healthcare plans require that you have already selected a primary care physical before receiving care, while others do not. Make sure you know what your health insurance covers and do not be afraid to call to ask more questions.

 File the Proper Paperwork

It’s very important to keep proper documentation of your medical records, including billing from your primary care provider for office visits or medication. The records will help to support your paperwork when making an appeal. If you have lost your paperwork, see if you can contact your doctor’s office to see if they have anything they can pull up from your records related to the incident. In addition to organizing your medical records, it may be useful to record your conversations with your insurance agency or have a written list of detailed notes about your conversation with your insurance company and follow-up items.

 Maintain Focus on the Issue

Although the process may be causing you undue stress, it is important to write an appeal that stays focused on the specific claim, rather than an accusatory letter. If you remain calm, brief, and professional in your writing you are more likely to be heard. If you can include evidence that supports your appeal include that information, as well as and supporting documents that may help your claim. Insurance companies often forget about claims or they take months to complete so set a deadline to follow-up based on your needs.

If you feel overwhelmed by the appeal application, we are here to guide you through the process. In addition, South Carolina offers a series of employee disability plans that may be able to help you if the incident has left you unable to perform your job. Short-term and long-term disability may help you get through the difficult period and the financial benefits may help to mitigate some of the stress if your claim has been denied. At Callihan Lohr & Syracuse we have attorneys who are trained to specifically support clients who are thinking about or have already entered into the appeal process. We will help to provide you with the best information possible so that you can make the right decisions for yourself and your family.