Fighting the Good Fight

Gib Smith, Esquire

Unfortunately many people simply accept health insurance denials without question. Such blind compliance is often a mistake. Insurance companies bank on their members' ignorance of their insurance policy. This issue becomes exceptionally acute with those families dealing with a chronic or terminal illness. By taking time to follow certain steps, insurance problems can be prevented and perhaps an insurance denial overturned.

  • Read your policy carefully and review it at least once year. You should know its provisions, especially the exclusions/limitations and appeals sections. Make sure your physician and other healthcare providers understand your financial position and what your insurance does and does not cover.
  • If your policy mandates prior authorization of a procedure or a second opinion, do it! Otherwise your claim can, and probably will be, denied. Never assume that just because your physician orders a service, your insurance company will cover it. Remember your doctor is a medical expert, not an insurance agent.
  • If you have insurance through your employer, become acquainted with your employer's human resources department, as well as your insurer's customer service staff. Whenever you have a question or concern ask for the same person each time. The better the relationship the better the service.
  • Keep a log of names, dates, and notes about your appointments, procedures performed, phone calls made, claims filed, and agents contacted.
  • Keep copies of all correspondence with your insurance representatives and medical professionals. This includes your Evidence of Coverage (EOC).
  • As a follow-up to every conversation with your insurance representative, send a letter confirming the conversation's outcome. Make sure keep copies of all correspondence sent.
  • File your claims promptly and accurately to help ensure timely payment.
  • If there is a delay in payment of your claim, call your insurance company immediately. A delayed claim can signal a problem.
  • Try to pay by check so that you will have proof of payment in case questions or disputes arise. Save your canceled checks and all receipts for payments.

Should you have any questions or concerns as you strive to keep pace with your insurance company the Childhood Cancer Ombudsman Program (CCOP) is an excellent resource. CCOP is staffed by volunteer attorneys, disability rights specialists, and insurance experts. CCOP can be contacted via CBTF.

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