Negotiating Claims with Your Insurance Company: Helpful Tips | DC Metro Area Personal Injury Law Blog

Many Americans put their faith in health insurance companies, paying hefty premiums to be protected in the event of catastrophic or chronic illness.  Too frequently, in times of need, their claims are denied for technical or procedural reasons, or no good reason at all.  A recent article published in CNN Medical News chronicles the story of one family’s unjust treatment by an insurer, and includes the following advice for leveraging your position and negotiating more successfully with insurance companies regarding claim denials:

  1. Get help.  Your doctor, hospital business office, and employee benefits office can be much more powerful than you are. 
  2. Be persistent.  File appeals again and again, and to several different levels until you get a favorable resolution. 
  3. Use the right words.  Certain words, like “cosmetic,” or “to enhance esteem,” may trigger a denial, while appeals that include specific problems with “biting,” “chewing,” or “swallowing” may work to your advantage. 
  4. Ask your doctor to try again.  If a particular drug or procedure serves two purposes (for instance, it enhances the effectiveness of your chemotherapy, and also treats your anemia), then mention the second when you appeal a denial of the first. 
  5. You may need a lawyer.  The threat of a lawsuit with attorneys copied on your correspondence may get your claim the close attention it deserves.

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