Fight insurance denials. "Don’t be overwhelmed by a denial," Smith says. "Many states have agencies to help resolve disputes." Do a Google search for health advocacy agencies using your state’s name and words such as "ombudsman" or "health care advocate."
To tackle the problem with your insurer yourself, contact someone in the utilization or case management department and ask to discuss the denial. The first level of appeal involves submitting documentation explaining why an exception should be made.
"A persuasive letter from your oncologist goes a long way in getting tests covered," Weiss says. "It should state the purpose of the test and the question at hand. A request for an MRI is weak; a request for an MRI to rule out cancer because a patient has a history of cancer and irregular breast tissue is stronger."
Reconcile your medical bills to protect yourself from overcharging and possible coverage denials. While you’re in the hospital, keep a diary of all your medicines, including shots. Before you leave, get an itemized bill, says Katz. Match it up against your notes and the bill that comes in the mail. If it doesn’t track, bring everything to your next doctor’s appointment and ask him or her to explain confusing charges. If there’s a discrepancy, the doctor’s office may be able to talk to the billing department to straighten things out.
"Don’t let the billing department put you off by telling you, ‘Don’t worry, your insurance will cover it,’" Katz says. "You’ll need specific details to challenge a discrepancy, so it’s better to address it when the experience is fresh." Notify your insurer about any discrepancies. If you are unable to resolve your dispute, she says, send your complaint in writing with copies of the bills to the office of consumer affairs of your state’s attorney general’s office.
If you have trouble getting payment from your insurer, go to the Alliance of Claims Assistance Professionals for a referral to someone who can help, Katz suggests.
Originally published in MORE magazine, October 2006.
Updated October, 2009