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Resolving Issues With Health Care Claims

Health insurance provided through your employer can help to ensure you and your family get the medical care you need. However, too often, claims come back either denied or covering only a small portion of the costs. Having to pay additional amounts out of pocket can prove frustrating, particularly if you already pay a significant amount in monthly premiums. When it comes to major procedures that are denied or disputed, it can put your overall financial security in jeopardy. Our experienced Chicago health insurance claims attorneys details some of the common problems you are likely to experience and ways to address them. 

Dealing With Expenses Your Health Insurer Fails to Cover

Dealing with health insurance claims is often a frustrating experience. In some cases, the terms of your policy require you to pay a portion of the bill. In others, you may be stuck with the entire amount after the insurer denies your claim, often for seemingly no reason. According to the American Association of Retired People (AARP), roughly 200 million health insurance claims are denied or otherwise disputed each year. 

When you get a denial or a partial payment, it is important to be aware that this is rarely the final word on the matter. Steps to take in disputing the claim include:  

  • Carefully review all statements received from your doctor;
  • Compare these with benefit summaries received from your insurer;
  • Set up an online account with the insurer, which can often provide more detailed access regarding billing codes;
  • Contact both your insurer and your medical provider’s billing department to clarify any discrepancies. 

Appealing Denied Health Insurance Claims

If the above process fails to resolve the issue, there are other options available. This includes formally disputing the insurer’s decision by filing an appeal. One of the first steps to take as part of this process is to thoroughly review the terms of your health care insurance policy. Under the Employee Retirement Income Security Act of 1974 (ERISA), you can request copies of all policy-related documents from your employer, free of charge. 

Carefully review all the terms of your insurance, making note of any deductibles, co-payments, and co-insurance required. Check for policy exclusions, which are often used to deny coverage. Other steps to take include: 

  • Notify the insurer of your intent to file an appeal;
  • Inform the medical provider or facility;
  • Keep copies of all correspondence you receive;
  • Contact our Chicago health insurance claim attorney. 

Contact Our Chicago Health Insurance Claims Attorney Today

At Bartolic Law, we act as a strong legal advocate on your side when dealing with insurers. To discuss your options when dealing with a denied or disputed claim, contact our Chicago health insurance claims attorney and request a consultation today. 

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