What to Do When Health Insurance Denies Care You Really Need
If there’s anything worse than being sick, it’s being sick while dealing with insurance issues. But unfortunately, that situation is all too common. Recent research from the Commonwealth Fund, a private foundation that researches health care issues, finds that 17% of U.S. adults have in the past year had their insurance company deny doctor-recommended care, with denials happening about as frequently for people on both commercial and government insurance plans.
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Denials can occur either before you’ve gotten a test, procedure, or treatment—when a provider submits a request for prior authorization, for example—or after you’ve already received care. The insurer may argue the service isn’t one it covers or is medically unnecessary for you, or it may deny care on logistical grounds, like a claim having incorrect information or coming from an out-of-network provider.
Receiving a denial letter can be discouraging, but you can take certain steps to fight bac..