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Fight for your Rights
by Michael Plontz
As a caregiver you must be adept at
dealing with insurance issues. Especially in todayís
complicated world of HMOís, PPOís and long term care
policies. The language alone is enough to send you
packing. What happens if your insurer refuses to pay
part, or all, of your bills? It is not that uncommon.
What many people donít realize is that they can appeal
if their insurer says no. And people who know their
rights have an outstanding chance of winning those
Letís hope you never have to go through that. However,
as they say, ďAn ounce of prevention is worth a pound of
cure.Ē The following are a few suggestions on how to arm
yourself should the need to appeal a refusal of
insurance payment arise.
1) Save everything! Donít discard any insurance papers
or any papers pertaining to your treatment. Save
receipts for all doctorís visits and all prescriptions.
Save copies of referrals to specialists. When you are
speaking with any employee at the insurance company,
write down their full names, positions, extensions, and
whatever they tell you to do. Keeping all of these
things in a portfolio in some kind of order can only
help you organize.
2) Make sure your appeal is airtight. Writing a letter
stating your position is your first step. A letter is
documentation--a phone call is not. Your letter should
be detailed, yet concise. Include important information
like your claim number, group number and policy number.
State the reason for coverage denial then describe your
illness and treatment. Next, state why you believe that
your insurers made the wrong decision and then offer a
solution. Close by saying what you would like your
insurers to do. Your primary care physician and any
specialists involved should write letters as
well(provided they are on your side).
3) Obtain your doctorís full support. Your primary care
physician will most likely be anxious to stand by you
through this ordeal. After all, they prescribed a drug
or recommended a procedure that your insurer doesnít
want to pay for. In these cases, your doctorís support
is vital to your appealís success.
So donít take it lying down. You have certain rights as
an insurance consumer. A very small percentage of people
ever appeal under these circumstances, but it should
happen more. It is probably easier for the insurance
company to just pay the claim rather than fight it.