October 5, 2022

Bucks: 7 Steps in Appealing a Health Insurance Denial

It’s unsettling to receive a letter from your insurance company telling you that your request for medical care, or for payment of care you’ve already received, has been denied. But there are some steps you can take to help boost the odds of filing a successful appeal.

Martin Rosen, a co-founder of Health Advocate, a business that helps people who get their insurance through their employer navigate dealings with their insurance company, says the key to avoiding a denial in the first place is knowing the details of your insurance policy before you seek treatment. (The company also offers advocacy services, for a fee, through Patient Advocate Foundation can provide guidance for free. Fee-based services like Health Proponent are also an option. The service has been experimenting with different fee structures and is joining with affinity groups, like alumni associations and the American Automobile Association, to broaden its membership.

Health Proponent charges $29.95 a year for individuals and their families to join and charges additional fees, depending on the type of service it provides. If you have a claim denied, for instance, it will research the problem for a flat fee of $99. (That means using the service for claims of less than that amount doesn’t make sense.)

If you have uncovered medical bills totaling at least $400, the company will attempt to negotiate a reduced bill (there’s no upfront charge for the service, beyond the annual membership fee). The service previously charged an hourly rate for this service, Mr. Rosen said, but has switched to a percentage fee. If the company can’t negotiate any savings, you pay nothing to Health Proponent; if it does get the bill reduced, you pay 25 percent of the savings as a fee. (Say you are billed $10,000 which is not covered by your insurance, and the company negotiates the amount down to $5,000 — half the total. You pay $5,000 to the provider, plus a fee of $1,250 to Health Proponent. So you pay a total of $6,250, a savings of about 38 percent.)

Have you appealed a denied health insurance claim, with or without paid assistance? What was the outcome?

Article source: http://feeds.nytimes.com/click.phdo?i=8e4c2f89a49b285d3cba5717555840fe