Tips for Challenging Denials of Health Coverage

[Gladiator]

There are few insurance carriers that cover everything, without first denying the procedure.

http://www.ama-assn.org/resources/doc/psa/appeal-that-claim.pdf

There are some threads complaining about coverage. This thread is intended to deal with making the best of what can be improved.


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[solletica]

There are few insurance carriers that cover everything, without first denying the procedure.

http://www.ama-assn.org/resources/doc/psa/appeal-that-claim.pdf

There are some threads complaining about coverage. This thread is intended to deal with making the best of what can be improved.




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Simply appealing claims thru one's insurance provider is dumb.

Best way to deal w/insurance companies is via heavy legal intimidation, i. e. sending letters from lawyers to insurance cos., copies of complaints to state insurance regulators (i. e. Dept. of Commerce) along with the initial claim.

 

[Ray410]

Simply appealing claims thru one's insurance provider is dumb.

Best way to deal w/insurance companies is via heavy legal intimidation, i. e. sending letters from lawyers to insurance cos., copies of complaints to state insurance regulators (i. e. Dept. of Commerce) along with the initial claim.

It's important to keep in mind that whenever you have a complaint against any large corporation, as soon as you mention lawyers, all further communication will be referred to their legal department, which will rudely freeze you out. So do not go that route unless you actually plan to file suit. Employees are instructed to stop talking to you when you mention lawyers and refer all further calls to the legal department. Try to handle your complaint on the lowest level possible, never call names, bluff or swear. If you have to hire a lawyer to win, do so and go full bore. But only after all other reasonable avenues have failed.

 

[solletica]

It's important to keep in mind that whenever you have a complaint against any large corporation, as soon as you mention lawyers, all further communication will be referred to their legal department, which will rudely freeze you out.

It's also important to keep in your mind that the "advice"/info you're offering here is nothing more than stupid, mindless claptrap straight from the insurance cos. themselves.

Legal intimidation doesn't remove the right to appeal a claim; it just tells the insurer you intend to pound their face into the ground if they screw you over. And in doing so, it expedites the likelihood of swift claims payment. And threats, recording of calls, etc. other pre-emptive regulatory action all help.

There's a word for patients who play by the rules: victims.

 

[Ray410]

It's also important to keep in your mind that the "advice"/info you're offering here is nothing more than stupid, mindless claptrap straight from the insurance cos. themselves.

Legal intimidation doesn't remove the right to appeal a claim; it just tells the insurer you intend to pound their face into the ground if they screw you over. And in doing so, it expedites the likelihood of swift claims payment. And threats, recording of calls, etc. other pre-emptive regulatory action all help.

There's a word for patients who play by the rules: victims.

No. Understand this: Corporate employees don't care about your threats, they are not personally involved and will lose nothing out of their pocket no matter what happens. You will scare no one. Bluster will only earn you a referral to the lowest employee in the legal department, who will put a brick wall in front of you. Your post sounds like you have no experience with this whatsoever. Enough of my time, do as you please.

 

[solletica]

No. Understand this: Corporate employees don't care about your threats,

Yes they do, because they don't like to get sued, esp. when you have phone evidence, etc. of fraud being committed by them.

Spare us your claptrap; save it for the insurance co./lobbying firms.

 

[274ina]

I have a better solution.

Ban health insurance.

Universal Health Care. No greed. No CEO. No bills. No CEO death panels.