InsurRejected5 Tips for working with insurance companies

Having a health insurance claim or request for services denied can be really frustrating.  There are two ways to avoid these situations: making sure you dot your i’s and cross your t’s so that a claim isn’t rejected in the first place, and knowing what to do when your request runs afoul of the system.  Here are some tips that can help you do both:

1. Know Your Coverage

Does your plan offer mental health services? What about support services ranging from in-home care to special needs day programs? If you dig into the details of your health care plan, the breadth of services offered may surprise you.

2.  See Your Primary Care Provider as an Advocate

Chances are you’re going to need specialty care. But most insurers require you go to your primary care provider (PCP) first, who can then refer you to a specialist. Consider your PCP as home base – the hub that keeps all your records, knows your family’s story, and can send you to the right place as needed. Your PCP can be your advocate for the services you or your child needs, as well as help you stay in front of insurance problems.

BoxingChild3.  Know How to File an Appeal

Even before there’s a problem, understand the mechanics of how to file an appeal for the denial of a claim. Where do you send the appeal? What must it include? What forms should you use? When you file your first appeal, it is a good idea to take notes so that it’s easier next time.

Following-up with insurance companies might just be that perfect task for a friend who has been asking how he or she can help you.  Social workers at the hospital also can come to your aid when making an appeal to an insurance company.

4.  Understand the Reason for Denial

Insurers frequently have very specific guidelines for what they cover and the process that needs to be adhered to in order to receive coverage.  In many cases, it can be faster and easier to jump through the hoops and satisfy what is required than it is to try to get reimbursed if a specific process was not followed.  By first knowing the insurance company procedures, you can make informed choices.

5.  Never Deny Yourself or Your Child the Vital Care You Need

If the situation presents itself and you or your child is in need of immediate care and you are unsure about reimbursement, it is critical that you seek out the necessary care.  Although it may seem drastic to enter a hospital system through the emergency room, there may be times when this is what the situation requires.  If you are faced with making this important decision, please seek advice from someone you trust and get the medical attention your child needs.

Kristi Pikiewicz
Dr. Pikiewicz earned her PhD in Clinical Psychology at Pacifica Graduate Institute in Carpinteria, CA. She completed pre-doctoral training at the Nan Tolbert Nurturing Center in Ojai, CA, and her post-doctoral internship at the Boulder Institute for Psychotherapy and Research. At both sites, Dr. Pikiewicz worked with a range of adult, adolescent and child clients in individual, couple, family and group settings. She also holds a B.S. in environmental science from Allegheny College and a teaching credential from Western Washington University.
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