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Battling an Unfair Health Insurance Claim Can Really Pay Off
Posted by nick_niesen on October 29th kd 12 kopen , 2010


Are you having trouble getting your insurance company to pay your medical health costs? Join the club. When managed care entered the insurance scene a decade ago, its mandate was to contain rising medical costs. One way to do that is to deny claims, even when claims are legitimate. The consumer backlash led to many states establishing independent review panels and requiring insurance companies to develop in-house appeal procedures. Forty-two states now have independent review boards whose decisions can override those of insurance companies. Most consumers don't even realize these review boards exist.


Another problem is that too many people just give up when their insurance claim is denied initially. The appeals process can be long and frustrating and many people don't have the patience or time to pursue a claim no matter how legitimate. People must be persistent and they can win. Particularly if there's substantial money involved kd 11 kopen , the time you dedicate to appealing insurance company decisions can pay off usually more quickly than you think. A Kaiser Family Foundation study recently found that 52% of patients won their first appeal for each claim made. The insurance companies aren't getting with out paying anymore.


If your first appeal gets turned down, press on. The study found that those who appealed a second time won 44% of the time. Those who appealed a third time won in 45% of cases. Which means the odds are in your favor no matter how long it take. Remember that every time you appeal it costs the insurance company more money to fight you and they are not only going to lose money to you, but also in court costs. Medical health benefits are particularly tricky because insurance companies usually have a cap on the amount of money they'll spend in a given year kobe X kopen , or on the amount of visits they'll pay for. But there's often some flexibility when you can document that you or your child's health warrants more care than your policy usually covers. Here's how to get started:


Do Your Homework


Read your Policy: What are the benefits? Which kinds of services are included? Outpatient or inpatient care? Is it a serious or "non-serious" diagnosis?


Know the law: Contact your local Health Association to determine your states legal requirements regarding insurance payments for all illness. Does your state require full or partial parity? Are parity benefits available only to patients with "Serious Illness" or is a so-called non-serious illness also included?


Provide written documentation: Some insurance companies may not consider some diagnosis's serious. In this case, you will need documentation to validate required services. Obtain a letter of medical necessity from your doctor and get test results showing the medical need for you or your child to receive certain services, based on the diagnosis.


Keep good records: Remember kobe 11 kopen , you'll be dealing with a bureaucracy. Keep the names and numbers of everyone with whom you speak, the dates on which you spoke, and what transpired in the conversation.


Start early: If you can kyrie 4 kopen , start the appeals process prior to initiating treatment. If the doctor says your child will need to be seen once a week for a year, begin immediately to appeal your insurance company's policy of reimbursing only 20 visits a year.


Call and Ask the Insurance Company:


What are the prerequisites for receiving health benefits?


How many visits are allowed annually for you or your child's diagnosis? Can multiple services be combined on one day and be counted as only one day or one visit?


Which services must be pre-certified--by whom?


Be positive, polite and patient with the customer service representative. Remember that heshe is only the messenger kyrie 5 kopen , not the decision-maker. They are the gatekeepers and can either provide you with access to a decision maker or make your life miserable, depending on how you interact with them.


Be persistent. There are no magic bullets. Be like a dog with a bone and don't give up until you get the answer you want. If you get nowhere after several calls, ask for a supervisor or a nurse in the pre-certification department.


Remember that you do have the right to appeal if your claim is denied. Most consumers get discouraged and will not continue to pursue a claim that should or could be paid. Insurance companies count on that happening lebron 14 kopen , so get out there and claim what's justifiably belong to you.


Why Having Good Friends is So Important Self Help Articles | August 11, 2010

We all need friends around us.? We like to share our lives and our thoughts.? This is part of the way we live and central to how we build our sense of self.



If you watched the movie "Bride Wars" you will have seen a great depiction of the importance of having good girl friends. Those two girls had been friends since they were knee high to a grass-hopper and total devastation was caused when they had a fall out. They had no-one else who they could talk to in the same way. The sense of loss and hurt was clearly shown.


The sense of betrayal was even worse when one sensed the other doing something which was hurtful. Anyone else could have done that same thing and it wouldn't have mattered very much; but when it's your best friend who does something like that - that is just NOT on. We rely on our friends support and shoulders more often than we fully appreciate.