In case your health insurance claim got denied for Bariatric Surgery, you may want to appeal against the decision. But how do you do that?
These six steps will hopefully help you:
- Get a written denial letter from your insurer
First, obtain a denial letter that contains all the basic information. Apart from mentioning the name, the credentials, and the title of the person who denied your claim, a denial letter needs to include the clinical rationale and the medical criteria supporting the denial. A denial letter must also contain instructions to appeal to the decision. In addition to that, contact information, instructions for correctly filing external review and for obtaining further assistance need to be given.
In case the denial latter given to you lacks any of the above mentioned elements, contact your insurer and get the additional information.
- Understand the guidelines
Before going ahead with your appeal, you must take the time to understand the appeal guidelines of your provider. Different insurance companies have different guidelines, and to maximize your chance at winning, following guidelines is important.
- Get support from those who are willing to help
Most reputed medical centers have insurance coordinators who know a lot about the appeal process. Contact your Bariatric medical center to find out if someone can help you. In case a bariatric coordinator cannot find success, you may even request your bariatric surgeon to call someone in the insurance company who has high authority. In addition to that, your company’s HR center may be of great help, too!
- Prepare an effective appeal letter
Never write a weak unprofessional letter. Put effort to prepare an appeal letter that looks highly professional and standard.
- Keep track of your correspondences
In addition to noting the times and the dates of each of the correspondences, you should note the medium of correspondences, too. That is, whether a discussion took place over phone, email, fax or something else. You must also keep track of all the titles and names of the different representatives you speak with. Other than that, save a summary of whatever is talked about during any correspondence. Further, make sure that you send your letters using certified mail carriers only. That way, you can have proof regarding when you sent those letters.
- Make sure that you follow up
All your efforts will be wasted if you fail to persist. Make sure that you do not stop your journey until you get a final official response from your insurance provider.
If your insurance provider does not budge even after you follow the above steps, you may want to go a step further and involve lawyers and other influential third parties.
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