What to Do if You Have an Insurance Issue

Insurance issues are a huge headache no one wants. Many are in the habit of tossing out their insurance benefit of explanation or claim statement when they receive them in the mail. It is so important to read them and make sure they are correct.

I was once charged for a service I never received so when I did need the service it was denied, and I was forced to pay out of pocket. I had to pay for a service that should have been covered by the insurance all because I overlooked this mistake. At the time, I did not realize I could fight the mistake or where to start even if I wanted to.

An article written by Lise Sullivan, MS helps to shine light on what can be done to increase your chances of resolving these tricky insurance matters. Number one thing to do for a denial or insurance issue is to act by contacting someone who can help. The writer encourages readers to contact their insurance broker or HR Department to help resolve the matter. These individuals typically have encountered a variety of insurance issues before and may have a way to resolve the matter or have additional contacts who may be able to help with the issue.

 The writer also suggests that you contact the insurance company directly to get clarification on the issue or why a claim was denied. A great way to start the call is to say, “Can you help me”. When you ask for help it send a message that you are trying to work together to resolve the issue. Always stay calm but firm when talking to insurance representatives. The representatives can be a gateway to getting a situation corrected. The writer also has advice on the next steps to take if the representatives were not able to resolve the issue. For example, insurance companies often have an appeal process that can be initiated by completing the correct paperwork.

The writer of the article also encourages you to reach out to your local SHIP (State Health Insurance Program) representatives who may be able to advise you on the matter. SHIP counselors have been trained on matters related to Medicare and Medicaid however they often have information and are helpful on private insurance as well. You are your own biggest advocate and education is power so know your rights and do not be afraid to ask questions. Click on the link below to read the article and learn more about how to protect your health insurance rights.

If you have an insurance issue and not sure where to start, you can always reach out to our Care and Outreach Coordinator to assist you.