By Sandra Block
USA Today
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A serious illness is hard on the body and the mind. If your health plan refuses to pay some of the bills, you may feel too weary to fight. But you have a right to appeal those decisions, and the odds of success are better than you may think.
Health plans deny claims for all kinds of reasons. Your insurer may argue that a surgical procedure is experimental or your medication isn't "medically necessary." Your plan may decline to pay the full amount because an out-of-network doctor performed the service. Sometimes, claims are denied because they were coded improperly.
The problems are compounded for people with chronic illness, who often file dozens of claims, says Jennifer Jaff, author of "Know Your Rights: A Handbook for Patients with Chronic Illness." "The system is built for people who get sick, get treated and get better," she says.
Jaff, who has battled Crohn's disease, a chronic inflammation in the small intestine, most of her adult life, says individuals with chronic illnesses often have to fight for coverage. "We are absolutely by far the most expensive bunch of people, so insurance companies will look for reasons to deny coverage."
But just because a claim is denied doesn't mean you should pay it. All states require health insurance plans to have internal review procedures, and about 70 percent of appeals are successful, Jaff says.
How to improve your chances:
Robinson created a computer program to track his son's bills. It proved invaluable in filing appeals, he says. In many cases, claims were denied on the grounds that a particular doctor wasn't included in his plan's network. Robinson's record-keeping system helped him prove that the doctor in question was covered by the plan.
Whether you use a computer program or a file folder, keep detailed records of correspondence with your insurer, medical records and bills. Take notes of phone conversations. Send letters through certified mail and request a return receipt. That way you can confirm they were received.
