What to Do When Your Health Insurance Denies Payment for Your Diabetes Care

Mary Ann HodorowiczBy Mary Ann Hodorowicz RD, LDN, MBA, CDE, CEC

We all know that taking care of diabetes can be stressful, even on a day-to-day basis.  It's a lot to juggle, so the last thing a person with diabetes needs is for a healthcare insurer to deny all or part of a claim for a medical service.  And, the last thing the person should do is panic!  The really good news is that there are proven steps to take that can greatly help to overturn the denial decision completely, or to get part at least part of the claim paid.  These steps are summarized in the table below; they come from well-respected health insurance regulatory agencies, including the National Association of Insurance Commissioners.

Step 1 - Read and Understand Your Health Plan
What You Need to Know:

  • Your individual health plan is a legal contract with an insurance company.
  • You have rights and also responsibilities.

What You Need to Do:

Read your policy to understand:

  • The medical services that are, and are not paid for.
  • The specific conditions for insurance payment (example: for what medical conditions, where the service must be performed, how many visits with the provider are allowed, etc.).
  • How much the insurer will pay for the service (example: 80% of the allowed, insurance adjusted reimbursable amount).

Call your insurance company if you have any questions.

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Last Modified Date: January 14, 2014

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by Nicole Purcell
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