After a personal injury accident or medical issue of any kind, having to deal with an insurance company can be a real pain, especially if there’s a dispute. Some insurance disputes can be handled easily, while others may be a very difficult process.
Below are some tips to consider if you’re facing a dispute with an insurance company:
Understand why the claim was denied.
Look over the EOB (explanation of benefits) document in your policy carefully. If you do not understand why the claim was denied, contact the insurance company and they are required to explain this to you in layman’s terms.
Basically, before you fight your battle, be sure you thoroughly understand what the battle is about.
Is it a small problem?
There are times claims are denied and can be fixed easily because a doctor’s billing code was entered incorrectly or other data entry errors, such as a misspelled name or wrong date of service. Check for such minor mistakes before escalating the dispute into a big deal.
Gather the evidence.
Collect all medical records – including test results, doctor notes, labs, bills, etc. – to establish your diagnosis and medical treatment.
Obtain a medical record.
If the insurance company is denying a particular type of treatment, a medical record may be necessary showing that you have tried other alternatives. Also, the insurance company may request another type of alternative that may not be medically equivalent, so you may need a doctor’s note saying that the alternative it is not beneficial for you.
Gather medical journal articles.
You may need these to show that the treatment in question is beneficial. Proving the safety and effectiveness of the treatment may be beneficial to getting your claim accepted.
If you are still having difficulties with your insurance company, consult a personal injury law firm that is experienced in handling bad faith insurance disputes.