BestQuoteUS.com posted a great article about understanding health insurance coverage, and the process to go through in case a health insurance claim is denied. The first thing they explain is that you need to understand that not everthing a doctor decides is medically appropriate may be covered under your own individual or group medical plan. Your health insurance policy is a contract between you and your health insurance carrier, and the medical services that are covered are outlined in your policy.

If Your Health Insurance Claim Is Denied:

1. Contact your health insurance company. You would be surprised how often miscoding a medical claim causes problem. Make sure that your problem is not a simple error that can be cleared up by a customer service rep. At the very least, even if they cannot correct the problem, make sure you understand why the claim was denied.

2. If contacting customer service does not resolve your problem, and you are not satisifed that was a reasonable decision, find out what the dispute process is with your insurer. It should be outlined in your insurance booklet or available from the company.

3. If you have problems disputing the cliam you may need to contact your state insurance department, or even contact a lawyer.

medical claim denied, health insurance, understanding health insurance coverage

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