Phil Cannella: You CAN fight your health insurer!
According to the Government Accountability Office, patients who receive a health insurance claim denial have a 39% to 59% chance of getting it reversed if they appeal directly to their insurer and a 23% to 54% chance if they appeal to a third party authorized to hear such appeals.
If you want to maximize your chances of getting the denial revised or reversed, take the following approach:”
- Check for errors. According to the American Medical Association, 19% of claim forms contain errors, with the main culprit being the wrong diagnosis or procedure codes improperly filled in by doctors and their office personnel. Check with doctors’ offices and your insurer if the codes are accurate.
- Make your case in writing. Refer to www.advocacyforpatients.org for tips on how to cogently present your arguments. Get your doctor to write a summary of your diagnosis, symptoms, and the health consequences if you have forgone medical treatment. Get a copy of medical records. Send these documents through the mail with delivery confirmation.
- • Escalate the battle to an independent organization if your appeal to your insurer does not end favorably. You can find information on local organizations on www.healthcare.gov.
- • When all else fails hire a patient advocate in your area. Refer to http://www.patientadvocate.org/ for details.
FOR MORE INFORMATION FROM PHIL CANNELLA, TUNE IN TO THE CPR SHOW, EVERY SATURDAY 11AM-1PM. LISTEN LIVE
