Evil Health Insurance Company, Why Do You Bother Denying My Claims?

Over the past three years, I’ve gotten quite good at battling my health insurance company, or hereforth known as Evil Health Insurer, for their denial of office visits and diagnostic tests recommended by my doctors.  I have to thank the internet for my newfound expertise. When my insurer first denied a legitimate visit to a specialist, I did some research and found very helpful tips on letter writing and on navigating the process in general.  Using these tips, I wrote a letter and included documentation to back up my claims.  A month later, they said I was correct and paid for the visit.

Since that first victory, they’ve denied various claims (for the same medical condition) at least four times. I’ve lost count.  Each time, I pull up my letter template…yes, I now have a handy insurance letter template…fill in the blanks, and re-attach supporting documentation from my benefits manual.  I recently won my latest battle and I admit that I’m feeling cocky enough to post about this. I want to say or shout from the rooftops:

Dear Evil Health Insurer,

You may screw over millions of people just when they need healthcare the most but you’re not screwing me. In fact, the next you see a letter from me, why don’t you just approve the claim without re-reviewing the case because you know I’m right!!!

Or better yet, why don’t you stop denying legitimate claims in the hope that the victim is too illed, too uneducated, or too busy to fight back?  I truly cannot believe that each denial is an honest mistake. I saw Michael Moore’s “Sicko” and have read enough horror stories to know that this is simply how most insurers conduct business.

Hopefully this post will become irrelevant if healthcare reform actually goes through. In the meantime, here are my tips if you ever get denied:

1 ) Your letter should not be emotional.  Be as factual as possible. Throw in legal-ese if you can!

2 ) Send your letter via certified mail. Don’t bother calling more than once. A paper trail is critical.

3 ) Back it up! Copy pages from your benefits manual that support your claim.

4 ) Keep a copy of your letter and use it as a template if/when you are denied again in the future. This saves a lot of time and makes the process less of a headache.

You can also ask your HR department for help if you’re not able to resolve this on your own. Remember, most people don’t fight back and insurers know this. They are more likely to approve your claim if you’re one of the few who bother to fight back. I don’t know if fighting back counts in my “Just Ask! Negotiations” challenge.  After all, my company and I pay for health insurance and expect legitimate expenses to be part of the deal. It’s not the same as asking for a better deal on rugs or shoes.

I’ve left out the name of this Evil Health Insurer because they’re all pretty much the same so I don’t feel the need to single them out by name

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2 responses to “Evil Health Insurance Company, Why Do You Bother Denying My Claims?

  1. I’m getting a little nervous about the reform that’s happening. Howard Dean, whom my liberal arse adores, has come out against it, saying that in its current incarnation, the health care bill is just an insurance company bailout. Our insurance provider came to my company, talking about how fabulous this reform is going to be, but we’ll just have to pay a bit more. Just…ug. I am baffled as to why we can’t figure out to care for our populace as a union.

  2. I truly don’t understand why this is a battle. In most of Europe, from what I understand, there is a public option that covers everybody. However, if you’re wealthier, you can still choose private insurance and other doctors. There needs to be caps on how much doctors, hospitals, pharmaceutical industry and insurers charge and I’m not sure that was written into the bill. I still think some reform (i.e. baby steps) is better than the status quo.

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