What to Do When Your Health Insurance Denies Payment for Your Diabetes Care
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.
Corn Chowder with Smoked Turkey Sloppy Joes Crispy Oatmeal Cookies Orange/Avocado Salad Apricot Sticky Drumsticks Colorful Veggie Omelet (Gluten Free) Pumpkin and Chickpea Salad Four Fruit Salad Fruit Bran Muffins Parsnip Mashed Potatoes with Leeks
I had a work dinner last night with some leadership from my office. I always find diabetes etiquette at these things to be kind of tricky. It was a four course meal, with salad, soup, entree' and dessert and coffee. There was also a selection of gluten free and non-gluten free dinner rolls. I felt way too full of questions for waitress... "Could I get my dressing on the side? How much sugar is in it?" A course later...