Health insurance company owe you money? Here are 3 ways to fight back— and win.
That might be why consumer satisfaction scores for health insurance providers have slipped to a 10-year low.
But you're not helpless: If your insurer has done something to make you unhappy, you can still come out on top.
Read on for three common disputes that consumers have with their health insurance company — and your best strategy to fight back.
You got a "surprise" medical bill
An unexpected medical bill can show up at your door after you unintentionally get care from an out-of-network provider, usually because you went to an in-network facility that employed out-of-network doctors — or sent samples to an out-of-network lab.
What to do: A couple of states have passed laws aimed at ending surprise medical bills, and others are considering similar measures. If you're not living in a state with such rules, you may still be able to get the bill changed.
Don't just pay the bill — or ignore it. Tell both your doctor and the insurer that you didn't realize the provider was out-of-network.
"A lot of times, your insurer and your doctor will work with you," said Sandy Ahn, an associate research professor at the Center on Health Insurance Reforms at Georgetown University Health Policy Institute, said in a phone interview.
Your insurer won't cover your preventive services
Under the Affordable Care Act, all insurance plans must completely cover preventive care, including blood pressure screenings, vaccines, and contraception. In short, you should be paying $0 for this basic care.
But the rules are not always as simple as you'd hope.
For example: You may not be able to get your preferred brand of birth control if there's a generic available — and you can be charged for the cost of preventive care if it wasn't the primary reason for your visit.
What to do: Call your provider. If your doctor agrees that sticking with a brand-name birth control is medically necessary for you, your insurer has to cover it.
Bills for preventive care when more than one treatment took place in a doctor's office may reflect a coding error. So call the billing department and politely ask that for a correction. Generally, it's best to prevent these mixups by booking separate appointments for preventive care and other services.
You've been denied treatment you need
Dealing with an injury or illness is difficult enough, but when you learn that a doctor-recommended treatment won't be covered by your insurance, the situation gets way more stressful.
What to do: Don't panic — what you need is an "appeal." All insurance companies have processes for handling both standard and expedited appeals.
Generally, you'll start by calling your insurer (find the number on the bottom of your "explanation of benefits") to find out why a claim was denied.
"Often it's just missing paperwork, or there's a mistake and it's easy to correct," Pat Jolley, clinical director of research and reporting at the Patient Advocate Foundation, said in a phone interview.
If that doesn't work, have your doctor or health care provider directly contact your insurer to explain why he or she prescribed the treatment.
Then, even if that's denied, there are two more levels of appeals: one with a medical director within the insurer, and one with an independent, third-party reviewer.
Check out a sample appeal letter — plus a detailed rundown of the appeals process — in this brochure from the Patient Advocate Foundation.