Parade, a Sunday news magazine (9/19/2004) includes an article suggesting what we should do when our insurance won’t pay. There is not space to quote the whole article, but here are the key points:
- Don’t get angry – but do get involved. Getting angry with service personnel is counter productive. Sometimes denials of coverage are no more than a business decision made by a computer.
- Hold on to your written records.
- Talk to your doctor – See if you have been denied coverage for a drug, etc., that the doctor thinks is absolutely essential for your well being.
- Realize that most plans base coverage on ?medically necessary.? This means that you are not entitled to the newest high-tech treatments, especially if they have not been fully tested.
- Do some research. The more you know about the medical treatment the doctor prescribed the easier it will be to talk with insurance personnel.
- Call your insurance company and say, “I am appealing my denied care.” Then put it in writing. According to law, insurance companies need to respond in a timely manner to written appeals concerning care. It is best to send your appeal by certified or registered mail.
- If you think a treatment or medication is urgent or required, get it. (8) If the insurance company fails to cooperate with you, then contact your state government’s Department of Insurance. All insurance companies are monitored in the USA by the Department of Insurance and must be approved by this Department to sell insurance in your state.
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