What can you do if your health insurance plan denies coverage for doctor bill?

Answer 1

It depends on why the ins. co. denied the claim.

Usually a simple call to the insurance company by the insured person is enough to get the insurance co to at least review the claim again.

If the policy is part of a group plan through an employer, you might want your human resources department to make the inquiry.

Often, insurance companies will deny a perfectly legitimate claim, because they know a percentage of patients will simply give up and walk away. They save lots of money this way.

The key is to be persistent. If there is any validity to the claim, they will eventually pay the claim just to make it (and you) go away.

If you suspect the insurance co. is not acting in good faith, let them know you are going to contact your state's insurance commissioner regarding the matter. You may also want to threaten to take legal action (sue) if they do not reverse their decision.

If they claim the procedures were not necessary, tell them you intend to sue the doctor, and you will compel the insurance co. to testify on your behalf. I've actually used this technique and it was very effective. They reversed themselves immediately on a $2000 claim.

You can also threaten to go public with your claim, use the local news media to publicize your plight.