If you were recently told by your doctor you will need expensive medical treatment, you may have been shocked to discover that your health insurance company will not cover it. If so, use the following tips to handle the denial to see if you can get the coverage you need.
Ask Your Doctor If an Alternative Treatment Exists
During your next doctor's appointment, ask if an alternative treatment exists that does not cost as much as the recommended one. Sometimes, the cost is the major barrier standing in the way of you having your treatment paid for by the insurance company.
If no other treatment exists, have your doctor write a letter that states that there is no other way to treat your medical condition. Have them send the letter to the insurance company, as well as give you a copy for your own records in case you need to consult an attorney.
Get Copies of Your Medical Records
Along with a statement from your doctor, get copies of all of your medical records pertaining to your current condition. While you can have the doctor send these directly to the insurance company, you should have a copy through which you can read.
After reading through the records, make a copy, and highlight important information about your condition that you feel the insurance company should see. This information could include life-altering or threatening lab results, as well as points in the doctors' notes stating that the treatment they recommend is necessary for your recovery.
Gather Evidence the Treatment Is Necessary
Along with your records, start doing your homework about your condition and the treatment you need. Look through medical journals and surf the internet to find articles about the treatment, including any statistical information about morbidity and mortality from patients who did not receive it.
Once you have gathered professional information about your treatment, send copies to your health insurance company. The information may shed light on the true importance of the treatment, and it may change their mind about covering it, especially if the long-term effects of your condition may cost them more money in the long run.
After trying to appeal to the insurance company about covering your medical treatment, you may still be denied coverage. If so, make an appointment with an insurance dispute attorney to discuss your case to see if they can file the required paperwork to overturn the decision and help you get the treatment you need for your health.