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When Insurance Companies Deny Payment
Bob Riter
bob@ibca.net
I sometimes assist cancer patients when their insurance company denies payment
for a prescribed test or treatment.
When people receive this kind of denial, they have the right to appeal. The
process is described in a letter that should be enclosed with the denial.
It’s hard enough to read and understand the “fine print” from
an insurance company under the best of circumstances. Being treated for cancer
is generally the worst of circumstances. Your energy is low and you’re
worried about things like possibly dying. Dealing with your insurance company
is not high on your priority list.
As a result, many people don’t appeal when they should.
A brief explanation of the process might help:
There are two types of appeal. The first is an “internal review”
which basically asks your insurance company to reconsider its initial decision.
If this internal review doesn’t find in your favor, you can then request
an “external
review” to be conducted by an independent third party.
In New York State, more than half of these appeals are successful, so it’s
important not to give up if you feel that the facts support you.
There are resources that can help. A good starting point is the New York Insurance
Department Hotline at 800-400-8882.
The Patient
Advocate Foundation (800-532-5274) publishes a brochure on the appeals process
that provides sample letters and suggestions.
A family member or friend might take on your appeal as a special project. I’m
often asked, “How can I help my loved one with cancer?” This is
one terrific way to do just that.
In some situations, it may be worthwhile to retain an attorney, especially if
the appeal is needed to get access to care or if large amounts of money are
involved.
We’re also happy to talk with you here at the Cancer Resource Center.
We can help you understand the process and direct you to the most appropriate
resources.
From the Ithaca Journal, November 29, 2007
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