The claims service is important and it matters a lot when you have questions or problems related to claims process, or claims exchange. Unfortunately, most people choose insurance companies based on price, not value. Health claims are often denied for minor technical reasons. Here is a simple guide to follow whenever claims are denied:
First action: Call the insurance company's claims office and ask for an explanation. Why was the claim not paid? It is often a simple problem that can be quickly corrected. Claims trade process is not easy and can be very tiring. At times like these you can search online for possible claims trade solutions.
Second action: Appeal the claim. You will see in any "Explanation of Benefits" a procedure to appeal any claim that has been denied. Follow this path, keep a copy of everything. You must appeal within a limited period of time. Always send an appeal by certified mail to establish the date it was made and to whom it was sent. An appeal requires a higher level of evaluation and usually transfers the claim to a special claims appeal review department.
Third action: Follow up on the appeal with a phone call. Typically, you will receive an appeal response by mail within a specific time period outlined in the appeal process. If you do not receive a timely response or a response that you do not understand, call the claims appeals office and ask for help. Ask for a supervisor if you do not get an adequate response.
Fourth action: Request a copy of the clause of the contract that affects the result of the claims and read it again. Have the claims representative or supervisor explain the contract language and why the claim is not eligible for payment.