Ensuring Quick Health Insurance Claims Review
Part 1: The Basic Tools, Chapter 3: Developing a Systematic Approach to Dealing with Health Insurance Page 17
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If you're going to attach a doctor's letter to the claim appeal form, it's helpful if all related background information is included in that letter. Although the insurance company may have detailed records of your illnesses and your medical history, it may speed up the appeals process if a summary of that information -- certified by a doctor's letter -- is included with each claim appeal that includes a letter from a medical provider. Insurers deal with thousands of claims, and the person evaluating your claim appeal may not necessarily be aware of the details of your diagnosis or your medical history.
If you're uncertain what information or documentation should be included with your claim appeal, call the insurance company and discuss the situation with a company representative. However, it's important to be aware that in some insurance companies, the people who answer the telephones may not be expected to provide detailed information or to fully explain insurance company policies.
If that's the way your insurance company is organized, ask to speak with a supervisor. Supervisors have generally worked at the company for a long time, and are usually very knowledgeable about policy rules. If you call your insurer to discuss a claim problem, and you find a particularly helpful supervisor, ask if you can mail or fax your claim appeal directly to that person. For future reference, include the supervisor's name, telephone number, and fax number in your information file, as well.
Claim appeals should always be made in writing, so that there's a record of the appeal. They should also generally be sent to the insurance company by certified mail, with return receipt requested, so that you have a record that the appeal was received by the insurer. In addition, the envelope in which the claim appeal is sent should have the words "Claim Appeal" written in large letters in the address to make certain that the appeal is forwarded to the correct department. Be certain also to include a copy of the original medical bill and the EOBS with your claim appeal. Keep a copy of all of the documents that you send to your insurer for your own records, of course. Following these procedures will help ensure that your claim appeal will be reviewed as quickly as possible.
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