Fight for your Rights
by Michael Plontz

As a caregiver you must be adept at dealing with insurance issues. Especially in today’s complicated world of HMO’s, PPO’s and long term care policies. The language alone is enough to send you packing. What happens if your insurer refuses to pay part, or all, of your bills? It is not that uncommon. 

What many people don’t realize is that they can appeal if their insurer says no. And people who know their rights have an outstanding chance of winning those appeals. 

Let’s hope you never have to go through that. However, as they say, “An ounce of prevention is worth a pound of cure.” The following are a few suggestions on how to arm yourself should the need to appeal a refusal of insurance payment arise. 

1) Save everything! Don’t discard any insurance papers or any papers pertaining to your treatment. Save receipts for all doctor’s visits and all prescriptions. Save copies of referrals to specialists. When you are speaking with any employee at the insurance company, write down their full names, positions, extensions, and whatever they tell you to do. Keeping all of these things in a portfolio in some kind of order can only help you organize. 

2) Make sure your appeal is airtight. Writing a letter stating your position is your first step. A letter is documentation--a phone call is not. Your letter should be detailed, yet concise. Include important information like your claim number, group number and policy number. State the reason for coverage denial then describe your illness and treatment. Next, state why you believe that your insurers made the wrong decision and then offer a solution. Close by saying what you would like your insurers to do. Your primary care physician and any specialists involved should write letters as well(provided they are on your side).

3) Obtain your doctor’s full support. Your primary care physician will most likely be anxious to stand by you through this ordeal. After all, they prescribed a drug or recommended a procedure that your insurer doesn’t want to pay for. In these cases, your doctor’s support is vital to your appeal’s success. 

So don’t take it lying down. You have certain rights as an insurance consumer. A very small percentage of people ever appeal under these circumstances, but it should happen more. It is probably easier for the insurance company to just pay the claim rather than fight it.