One of the toughest struggles that one might have to face, in context to health insurance plans, is when they have to convince the insurer to recognize upon the claim that they are disputing. Winning a case in such circumstances can be a rather long drawn process. However, that by no chance does mean that it is not possible at all to win these cases. Yes, it is actually possible and the struggle is worth it as well. Obviously so as the prices of the health insurance plans are always on the high rise.
Here is a list of a few useful steps that can contribute to make certain that one has better chances of winning a Healthcare insurance claim dispute.
1)The first and foremost thing that needs to be done is all the paperwork is to be gathered together, each and every scrap that stands relevant to the claim by any chance. This includes the policy, all the relevant and associated medical bills and any correspondence that might have taken place with the New York Health Insurance company in regard to the claim in question.
2)The second step is to carry out a thorough study of the claim denial and preparation of the documents accordingly. One should start by reviewing the information in the claim denial draft that is provided by the insurer. The policy holder needs to have a very clear idea of the exact point basing on which the insurance company has chosen to reject the claim. The reason could even be that the staff at your doctor’s clinic did not supply them with all the necessary details, information and bills which are required by the insurance company. In such cases it is not at all a problem to resolve the claim and bring the matter to a rest.
3)The third step is to contact the insurance company and speak with a claims adjuster or a customer service representative. Explain to the person in detail how you have thoroughly studied the New York Health Insurance policy along with the additional documentation and that you are of the view that denial of your claim was an error without a doubt. Thereon ask for a date when your claim will be subjected to resolution. Do not hang up the phone unless and until you are provided with an exact and tangible date. Also do not forget to find out the name of the representative you talk to. If you do not hear from the Insurance Company by the date they mentioned, call back the customer care representative and follow up the process. Also document all the phone call conversations including the exact date, time and designation of the representative you speak to.
4)Think whether it is appropriate to file and appeal or not. In case the claim is not successfully resolved, an appeal will be the option that one is left with. Each of the American states have its own appealing process, so contact the insurance department in your state and find out what is the process of filing the case in your State.
You need to have a very clear idea about how your new york health insurance plan works: It is absolutely vital for you to have a sound understanding of how the health insurance plan works in the first place. To know more about new york health insurance, please visit our website http://www.healthinsuranceweb.com/states/new-york-health-insurance/
Article By: wilsonstrake
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