It isn’t at all unusual to find yourself having to file multiple appeals for insurance bills. Especially, with ongoing treatment. Or if you find yourself in the hospital for any period of time, the majority of the subsequent bills you receive may be wrong. In fact, 80% or more of medical bills are incorrect. Therefore, it is very important to properly review and manage them in a timely manner. In the event, you need to file an appeal you need to have all of your records ready to go.
There are certain denials that can be appealed.
When your insurance company says no to paying a bill, you have two options. Accept what they say and possibly pay more than you should or submit an appeal. When you are denied payment the insurance company is required to tell you why they’ve denied your claim or ended your coverage. They also have to let you know how you can dispute their decision. You also have a right to have a third party review their decision
There are two ways to appeal a health plan decision: Internal and External. Here we are only going to discuss the internal appeal process.
This is an appeal with the insurance company in-house. If the case is urgent, your insurance company must speed up this process.
There are 3 steps in the internal appeals process:
The internal appeal must be completed within 30 days if your appeal is for a service not yet received and in 60 days for a service you have already received. If denied they are required to tell you why, make payment, or you can ask for a second external review. In the insurance company’s final determination, they must tell you how to ask for an external review.
Make sure you have all of your documents and keep copies of everything you file. Take down the name, date, and time of every person you speak with. Don’t give up. Stay the course.
If you have questions about how to navigate the financial impact of having myeloma, consider reaching out to a Myeloma Coach. There are many who have experience in financial resources, including Financial Coach Diahanna Vallentine. You can view all Myeloma Coaches and their areas of experience on our website: www.myelomacoach.org If you have successfully navigated the financial impact of myeloma treatment and would like to share what you've learned with others- consider becoming a Myeloma Coach.
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Editor's note: this is part one in a series of articles on this topic.
about the author
Diahanna is the Financial Program Manager for the HealthTree Foundation. She specializes in providing financial help, resources and education for multiple myeloma patients. As a professional financial consultant and former caregiver of her husband who was diagnosed with multiple myeloma, Diahanna perfectly understands the financial issues facing myeloma patients.