Insurance claims denied !!! Tips on how to get them approved

As a Mom of a child with Chronic illness and a connective tissue disorder health insurance companies are my Frienemy . They cover a majority of our   health bills which  without I would be living  on the street. But their endless fee increases and claim battles drive me CRAZY..

6 years ago when my husband started his own company we decided to take individual insurance for 2 reasons.

1: it meant that we did not have to stay at a job we did not like just for benefits nor did we have to increase everyone’s else premiums in the plan because we were chronically sick

2: because the individual plan had no lifetime maximum. Why is that important ?? well with a kid who always sick it is super important . Maxing out his health coverage before he was 21 would be a huge problem.

I never want to not be able to get him treatment for something because he was no longer insurable. So needless to say we pay and arm and a leg for health care a month in fact  it is our single  biggest expense every month!!!!

So last week I got a bill from my Dr’s office dating back to 2007/ 2008 . There were 13 charges of $10  a total of $130 owed. The Dr’s were charging me the difference between what I paid on the day and what the Insurance was telling them I should have paid.

After 1 hour on the phone and a lot of frustration we figured out that when my plan increased in 2007 the system wiped out our elected  primary care physician from our system . So they were billing me the difference between a primary care visit and a specialist visit.

I was quick to explain that any system change was surely not my fault  she very quickly responded  that yes it was . She said as the customer it is my job to always check that everything is in order,   clearly read the instructions when new  cards are  mailed and to check that all details on the card were as before !!!!!

It was at that point Mr nice guy got off the phone and I asked to speak to a manager who after explaining the whole story to again agreed to adjust the claim . However not before having to submit a request to re open the claim since more than a year had passed they technically not able to do anything!!!

However she did remind me of one thing I am the customer!! The  one who pays a lot of money and that just because they are my health care insurer and we need them  I should not feel intimidated to question when they do not perform a service i have paid them to do.

It is only after years of battling this stuff I have manged to live through insurance calls with out going completely insane or bankrupt.

So here are some good tips to remember when dealing with insurance companies

ALWAYS document on the bill/claim you are calling about the date and time you called and ALWAYS get the name of the person you are speaking to.

Write a brief description down on the bill in question to document what was discussed and agreed upon.

Never TAKE their denial as a final answer. I was once told insurance companies deny claims the first time around because 7 out of 10 people will accept the denial and pay it !!!!

Always request an appeal for denied  claims. If the appeal is Denied call again and speak to a manager about why is was denied and if the reason is not valid have your DR follow-up with a note .

If they think you’re not backing down you stand a much better chance of getting an approval notice.

FOLLOW UP if they do not call or send a letter call them back and stay on top of the claim.

Having time expire makes it very difficult to get the claim paid.

READ THE FINE PRINT as the lady told me it is your job the customer to read the terms and conditions of your policy … knowledge is power

TRY and be calm and polite when speaking to the representative ( this can be hard at times but try to remember that they are not the ones who make the rules they just deliver them).

LASTLY  keep copies of all records in a safe place for at least 3 years you never know when a bill will turn up and you will need to call and battle it out 🙂


About rebeccacronin

Good health , love and a happy family is what I strive for , smiles and sunshine what I run on.. . Germs my enemy, Dr's my friend and advocating and educating others what moves me forward...
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