Fighting Insurance Companies to Cover Medical Costs

When fighting for insurance companies to cover medical costs, you need to take control and have confidence to stand up to these big companies. No one else will fight this battle for you. Here are a a few steps to help you:

1. READ Your Policy
You have to know what your benefits are in order to fight for them. If there are any exclusions or limitations, you have to know what those are. Some policies require that you see only a certain group of physicians or have your laboratory services done only at particular facility. If you go anywhere else, they may deny or pay a reduced benefit. If you don't have your policy information call your provider, it looks like a booklet. I know exactly where mine is since I use it for reference constantly.

2. Understand the Lingo
Most of the time the policy contains a glossary of terms. If you run across a word that is not familiar look up the definition.

3. Know Who Your Providers Are
Do not rely on the physician’s receptionist to know if they are a provider. Call your insurance company and ask. They may mistakenly think they are a provider, but when the bill comes you may find out they are not. Take control.

4. READ Your Explanation of Benefits
This is a statement from your insurance carrier that describes what they are paying on the services that have been rendered. Go over this statement and make sure you are receiving all of the benefits you are entitled to. If there is any question in your mind that something has not been paid correctly, call the insurance company and ask for an explanation and then demand that the claim be adjusted. Do not take “NO” for an answer. So many times I have had to ask for a supervisor to help me and this should always be an option for you. Sometimes it just takes asking for a supervisor to get the claim adjusted correctly.

5. File an Appeal
If you are still not satisfied with the way your claim was handled, or the customer service person cannot help you, then file an appeal with your insurance company. Keep a written documentation of your conversation. With this documentation include the day, the time, and with whom you spoke with. Most of the time, conversations are recorded and this can at times work to you advantage.