There are some situations in which your insurance company will refuse to pay for medical expenses. This can happen in many ways – they may completely deny your claim or just a portion of it. It may involve minor incidents requiring minimal medical care costs to be covered. But other times, there are major procedures that are needed, leading to substantial medical costs that may be financially catastrophic.
Some people aren’t even aware that they have the option of fighting back against their insurance company’s denial of a claim. It’s always worth it to double-check your insurance company’s official policy to make sure they didn’t misinterpret their own rules.
Challenging the insurer’s reasoning
You may be able to apply your own common sense to the situation and find that it just doesn’t seem fair or logical. If you can come to that conclusion with a clear and rational head, there’s always a chance that the insurance company got it wrong and it’s worth looking into.
At the very least, you have the right to know what the reasoning was that led to the claim denial. You should never hesitate to request a full explanation from your insurer if there are any doubts in your mind.
Agents, HR, and providers are your friends
If you’re having trouble finding someone to talk to, the person you should ask for help with is either your personal insurance agent or somebody from the HR department. These are the people whose job is specifically to make sure your interests are protected, and they have a duty to serve you.
The good news is once the healthcare provider has backed up the claim, challenging the denial of coverage usually goes smoothly. Your provider will want to do everything they can to speed up the process of getting the insurance company to cover the costs simply because it is in their best interest.