Read this article in The Wall Street Journal about fighting health insurers when they deny coverage. It’s tough:
In any case, appealing an insurer’s decision is often complex and tricky, and the deck can seem stacked against you. It is often hard for consumers to know what is covered and what isn’t in an insurance plan. Indeed, insurers have been winning a majority of the cases reviewed by state regulators in recent years, with victories for insurers at 59% in 2006.
Here is what you need to know: get help.
The WSJ article provides several examples of patients doing just that.
Another option: get help from the start. Today’s health care world almost necessitates it.
Health advocates are the answer. From Marketplace:
Navigating that system — and, increasingly, fighting it — can be expensive. With coverage shrinking, people are looking for help in dealing with the details. There are doctors’ appointments to book, insurance companies to pay, medications to monitor. But there are companies that’ll shoulder that burden for you. For a price, of course.
The story highlights health advocate company Guardian Nurses.
Here’s what such a company can do for the patient:
Health advocacy companies make up a tiny fraction of the health-care field. But experts say the market is growing as people feel squeezed between full-time work and full-time management of their family’s health care. Advocates can search for specialists, book doctors appointments, and keep track of medications. They’ll also manage electronic health records, and provide a second set of ears during a consultation.
On a side note, according to the article, there is only one college that offers a health advocacy degree. Not that a specific degree is necessary to perform the functions of a health care advocate, expect more universities to offer similar programs.