Insurance Appeals and Denial of Coverage
Insurance companies
often deny payment for issues like medical necessity, non-covered
benefit, no pre-authorization, non formulary medication, out of network
and more. When these issues arise there is only one
thing that you can do, appeal ...appeal …appeal!
Insurance companies deal with member grievances
through their internal appeals process. To begin an
appeal, you simply need to contact the insurance company and state that
you would like to appeal the denial of coverage.
While this is a simple thing to do, HealthCare Advocates does not
suggest taking this approach. Why?
Because appeals are like little court cases, if you do not win your
case, you don’t get to start all over again. Further,
if you decide to initiate litigation (sue the insurance company) at a
latter date, you will likely be constrained to using the materials that
were used by the insurance company when rendered a decision on the
appeal/grievance.
HealthCare Advocates fights insurance companies
everyday when people receive an underpayment or a denial of coverage for
things like medical necessity; no pre-authorization; the plan begin
canceled for non-payment or late payment. The most
important thing to note is that HealthCare Advocates has the experience
to be successful. While many intelligent people try
to fight the insurance company, they forget one thing – intelligence
does not replace experience! And HealthCare Advocates
has the experience to be successful for you!
There is one additional advantage to using
HealthCare Advocates, our letterhead. As told to us
by a former