When Your Insurer Refuses to Pay: Fight Back by Following This Simple 5-Step Procedure
If your insurance company refuses to pay your claims, you can fight them, but you have to know how. Insurance companies are masters of finding loopholes that will permit them to deny a claim, which is why it's best to be prepared for claim denial before you ever experience one, instead of scrambling to figure things out when you're in the midst of it.
First, know that the majority of complaints originate from health insurance disputes over claim denial or payout delays, followed closely by car insurance companies. If you have a health or car insurance claim to put through, you'll have to be extra vigilant and know that you may have to fight to get what you're owed.
Maximize your chances of having your insurance claim paid out by following these steps:
1. Understand exactly why your claim is being denied
Your EOB (explanation of benefits) uses codes that help clients understand how an insurance company comes to its final decisions. Your EOB should also have a key that explains the codes. If you still don't understand why your claim was denied, call your insurance company and ask. You have every right to understand why your claim is being denied, so don't be afraid to ask and to demand that it be explained in terms that you understand.
2. Fix easy problems first
Claims can be denied over very simple things, like an error in your name or insurance ID number. Before panicking, make sure that all the documentation provided to you from your insurance company has the correct information. If you find an error, call your company to correct it before proceeding.
3. Get evidence
If your claim is being denied, you'll need to provide your insurance company with evidence to show that the services you want them to cover are medically necessary. You will need any relevant medical history, prescriptions, or other information that may help your claim get approved the second time around.
4. Stay organized
Your insurance company is very organized, so needless to say you're going to want to be organized as well if you want your claim to move forward. Keep pristine records and keep all your paperwork in one place. Save all receipts, any documentation, and keep detailed notes from every conversation with your insurance company. Always ask for the name and title of the person you're speaking to. Ask for any reference or appeal numbers and make sure you build a case with your own information.
5. Consult with a lawyer
While suing an insurance company should be seen as a last resort, you can consult with a lawyer to see if your case qualifies for further investigation. Find a lawyer familiar with going after insurance companies, lawyers like this from Darras Law understand more about the intricacies of going after insurance companies and what kind of outcome you can expect based on your case.