With news of the Anthem Blue Cross Blue Shield anesthesia policy change backlash last week, many of us are feeling vulnerable to arbitrary health insurance claim denials. Earlier this week, CNN reported that Blue Cross was going to change its anesthesia policy by putting time limits on coverage. Luckily, the insurance company decided not to move forward with the change. This begs the question though, what do you do if insurance denies your claim? There are ways you can appeal the decision. Here we’ll discuss steps you can take.
1. Find Out Why The Claim Was Denied
According to ProPublica, the limited government data available suggests that, overall, insurers deny between 10% and 20% of the claims they receive. PBS found that one insurer denied a staggering 80% of claims in 2020. Following the killing of Unite Healthcare’s CEO, shocking claim denials have flooded the internet.
If your claim was denied, first reach out to your insurance company. Have them provide a specific reason for the denial. The Affordable Care Act requires insurers to provide reasons for their denials. You can then use this information to fight the decision. Try not to panic. Most commonly claims are denied for a coding issue or fixable mistake.
2. Keep a Record
Make sure you keep a log of everyone you speak to, times, and dates when dealing with your insurance company. This information is vital if you file an appeal. Gather all the evidence that you can including medical records and labs and a letter of medical necessity from your doctor.
3. File an Appeal
Consumers usually file appeals less than 1% of the time. Don’t let your insurance company take advantage of you. First, file an internal appeal with your insurance company. This forces the claim to be reevaluated. Every insurance company has a different process for filing an appeal, so ask how you should start the process.
4. Don’t Give Up
Persistence shows the insurance company that you aren’t giving up on resolving this issue. Don’t be afraid to constantly follow up. Often insurance companies will try to give you the runaround, not return calls, or make you wait for answers. While waiting on hold may feel like a full-time job, don’t give up. If you are having difficulty, a patient advocate may be able to help.
5. Pursue an External Review
According to Healthcare.gov, you have 4 months to file for an external review. Your insurance company must accept the decision of the external review. Most states offer external reviews. If not, the Department of Health and Human Services will oversee the review.
Know Your Rights when Fighting an Insurance Claim Denial
Often, when insurance claims get denied the burden of enormous bills is placed on patients without resolution. If you continue to struggle to appeal a denied health insurance claim, you can also consult an attorney. Have you had any health insurance claim nightmares? We would love to hear your story.
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Teri Monroe
Teri Monroe started her career in communications working for local government and nonprofits. Today, she is a freelance finance and lifestyle writer and small business owner. In her spare time, she loves golfing with her husband, taking her dog Milo on long walks, and playing pickleball with friends.
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