Let the State Help Dispute a Health Insurance Claim
In 2004, an Ithaca, NY woman filed a claim with her health insurance company for a $154 infertility treatment. The insurance company denied her claim, as they did for almost 2,500 other claims for the same treatment.
But the woman from Ithaca was quite sure the insurance company was wrong to deny her claim. She disputed their findings, but they continued to refuse. So she filed a complaint with the New York State Insurance Department.
Turns out she was right. Last month, the New York State Insurance Department fined the insurer, and ordered it to reimburse those 2,500 women who had been denied payment.
Why is that important to us?
I often hear complaints from patients who don’t understand why a health insurance claim was denied. They tell me how frustrated they are trying to work with their insurance company. They phone their insurer’s customer service department, and are given answers they don’t understand, or answers that are incomplete. Sometimes they call more than once and get different answers each time. Too often, because they are sick and don’t feel strong enough, patients give up the fight.
That’s where the state Insurance Department comes in, to act as a watchdog for us, its taxpayer-patient-customers.
If you feel you have been unfairly refused payment for a health insurance claim, then take these steps:
Read your policy carefully, including the inclusions and exclusions, to be sure your claim should be covered. Exhaust all possibilities with your insurer. If you continue to be denied, then file a complaint with your state's Insurance Department.
You can find links to all state insurance departments and file your complaint online at http://www.naic.org/cis/fileComplaintMap.do
When you file a complaint, no promises are made about whether there will be an investigation, how long one might take, or that you will prevail in the dispute.
But if you are fed up, are sure you are right, and need a place to go where steps may be taken to prove your case, then know your tax dollars have paid for this valuable service that will help you arrive at the right answer.
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© 2008 Trisha Torrey |
