Insurance problems got you flabbergasted? First rule: Stay calm.
I never thought I would be on the wrong end of one of those insurance nightmares we’ve all heard about. How wrong I was!
Last year, as my wife was recovering from a life-threatening illness, I received a letter from the hospital that our insurance had denied the costs of the hospitalization, and asked us for over $260,000.
Honestly, I was in no danger of being able to pay this amount. I had never dealt with a problem like this before -- and wasn’t sure how to proceed. Our insurance used a clause in our policy to try and avoid their responsibility for the bill. Over the following months, I gathered information from insurance experts, claims adjusters, and lawyers -- and eventually convinced the insurer to pay the claim.
Perhaps some of the tips I got can help you to avoid your own insurance nightmare.
If You've Been Denied Coverage
-First, don’t panic. Getting this resolved will require a clear head.
-Review the notice from the insurance company. Be sure their reason for the rejection- it may not accurately apply to you.
-Get a copy of your records, and review them with your treating physician. Sometimes a letter to your insurer explaining the necessity or nature of your care can resolve the non-payment.
-If your claim was reviewed by an ‘independent’ physician, get a copy of their report, and be sure their explanation applies to your situation.
-Document all of your conversations with the insurer, by letter or by phone. (This gives you the advantage when different representatives within the company try to tell you different things.)
-Worst case scenario: If you have failed to resolve the dispute with your insurer, speak with the physician who provided the services, and explain the situation. Often, they will reduce their fees, or help create a manageable payment arrangement.
How to Avoid An Insurance Nightmare
-Obtain a copy of the insurance policy terms, and take the time to review it. It is important that you understand what your insurance covers, what it doesn’t and what you need to do to insure coverage.
-Review any amendments to your policy. It's remarkable how different a policy can become from the one you initially signed up for.
-Understand your deductible (your out-of-pocket expense.) Every week I am called by a patient who did not know or understand that her insurance would not cover everything.
Andrew Kirschner, D.O., is a board-certified physician with a private practice in Bala Cynwyd, Pennsylvania, and a consultancy in Miami, Florida. He specializes in treating individuals and couples with musculoskeletal and back pain. To learn more about his practice, please visit BackTogether.org.
