Unfortunately, there are many people who receive letters of denial from health insurance companies. There are a variety of reasons why this happens- some can be avoided, but not all. The truth is that certain individuals are higher risk and as health insurance is a risk business, they have to weigh certain factors to make the decisions that they do. Insurance is actually a gamble for both the insured and the insurer themselves because on either side- someone will lose money for the protection that is needed. Ultimately, the numbers are what wins, but there are a few things that you can do if you have been denied coverage.
Firstly, if you were denied on the basis of something that is inaccurate, you can dispute this. The way that the insurers receive the information about your health, whether you disclose it or not is through the Medical Information Bureau. This is something like the credit report for your health and contains medical records on anyone who has ever had health insurance of any sort and the conditions that they have had. You can do this once yearly at no charge. If you find errors, you can then go about filing the corrections and going from there.
If you have not yet been denied health insurance, or you have been denied by one company but wish to continue seeking coverage, it is a good idea to obtain a copy of this report so that you can either correct inaccuracies or better understand your position and your options. Further, one of the major reasons that people are denied health care coverage is due to age and smoking combined as a factor. Speak to your doctor about getting on a quit plan as soon as you can and see your doctor as often as you can afford to update your status in that- quitting will increase your chances of getting the coverage you need at a rate you can afford.
As to pre-existing conditions, do not fear that this automatically makes you uninsurable. There are some insurers that will accept patients with certain pre-existing conditions on an exclusion period, under certain conditions. An exclusion period is where the insurance company denies those claims relating to the pre-existing condition for a certain period of time. These greatly differ sometimes from state to state, so it is worth asking about. Bearing in mind that there are numerous factors involved in a denial of coverage, being able to find out exactly what that is and how it stacks up in your MIB report can help you to potentially find the coverage you need in time.
By: Henry Fleet
Posts Tagged ‘Insurer’
Potential Reasons For Health Insurance Denial
April 15th, 2010How To Dispute A Denied Health Insurance Claim
April 7th, 2010
When a health insurance claim is rejected, your next steps will determine whether you win a reversal in your favor or get stuck with a big bill.
Contact your health insurance provider. A claims adjuster should be able to review the denial and resolve the issue if there was just a simple error, such as an incorrect diagnostic code. Make sure to keep a written record of your call, including the date, time and name of the person you spoke to. If you don’t get anywhere with the phone call, request to begin the process of a formal claim review.
Ask for help. Take the details to your human resources department or benefits administrator. She/he should be able to call the insurance company for you or offer advice on how to proceed. You might also want to ask your doctor to call or write your insurance company to specifically explain why you needed the care you received.
Draft a letter. If the claim is still denied, write a letter to the claims manager and send copies to higher ups, such as regional vice presidents. Call your health insurance company for names and proper spellings. Politely explain why your claim should be covered and request a written response by a certain date.
Apply some pressure. If you still feel that your claim is legitimate and your insurer disagrees, file a complaint with your state insurance regulatory agency. Many states allow you to do this online. To find your state regulator, go to naic.org
By: Robin Boddy
Health Insurance 101
April 6th, 2010
Health insurance is a kind of insurance wherein the insurance company pays the medical costs of the insured individual if the individual in question falls ill due to covered causes, or due to accidents. The insurer may be a private organization or a government agency. The major purpose of health insurance is to cover medical expenses and any lost income while the individual is not well and unable to function normally.
There are different types of health insurance policies. The two most common ones are major medical and disability insurance. A major medical health insurance policy provides benefits for sickness or injury, irrespective of whether the care is provided at a doctor’s office, clinic or hospital. The types of sickness and injury covered are typically broad, although there are always limitations that you may want to discuss with your agent prior to purchasing the coverage. Major medical policies normally have an annual deductible and a lifetime maximum amount of benefits that will be paid.
Even if you are covered by a group insurance at work, you might consider taking an individual policy if you may change jobs soon, or if certain benefits that are not provided in the group policy.
A deductible is an annual amount that you will have to pay per insured person, before the insurance company begins to pay on your bills. There is an upper limit for the maximum amount of deductibles you will have to pay in a given year.
In a health policy, coinsurance refers to the percentage of the medical bills that the insured individual will have to pay after the deductible is met. Usually the health policy would have a provision called a ’stop-loss’ – this is the maximum amount you will have to pay for covered medical bills.
By: Chris Tolamalu
