When you are in a serious accident, such as a car or truck accident, knowing you have insurance should provide you with peace of mind knowing your medical costs will be covered.
This does not stop insurance companies from denying claims because they deem certain treatment as not medically necessary. Receiving notice of a denied claim can be devastating, especially while you are struggling to recover from your injuries and get your life back together.
Speaking with your insurance company
When your insurance plan refuses to pay for a medical claim, you have many rights. As a first step, you can try talking with your insurance company and verifying the specific reason for the denial.
Sometimes providing more information or answering additional questions from the insurance company about the medical treatment could result in a reversal of the denial.
When you speak with your insurance company, document all communication you have with them. Document the date and time of each communication, the name of the person you spoke with and the exact information they provided.
Many people do not like having conversations with insurance companies. Remain polite and respectful during your interactions with the insurance company, even if you are met with rudeness or hostility.
If the insurance company does not answer your questions satisfactorily or refuses to answer them, simply restate them in a different way. Do not be afraid to assert yourself and ask for a supervisor if you continue to feel that your request was not handled correctly or your questions were not answered.
Appealing a denial
If that does not work, you have a right to appeal the denial. Review your denial letter carefully as soon as you receive it. The letter contains information on your right to file an appeal and detailed instructions on how to file.
The letter also contains a deadline to file your appeal. It is generally a good idea to file an appeal immediately even if you have not yet talked to your insurance company.
This preserves your rights and avoids missing the deadline. If you resolve the matter with your insurance company while your appeal is still pending, you can usually withdraw the appeal. But missing your appeal deadline could cost you the right to fight the denial.
Your appeal hearing is your chance to provide testimony and evidence to show that the requested treatment is not medically necessary. Being prepared and organized increases your chance of a successful outcome.
Requesting an independent medical review
If your appeal is denied, you can request an independent medical review. This involves an independent physician reviewing your denied claim to see if the denial was appropriate.
When you have exhausted all efforts to reverse the denial, there might be other options left, such as pursuing litigation in court to force the insurance company to provide you with your necessary medical treatment.
Keep paying your insurance premiums no matter where you are at in the process. Sometimes people stop paying out of frustration over the denied claim but doing that will only cause more problems and potentially cause you to lose your coverage altogether.