Randy Galloway, of Star Telegram and ESPN fame, used to call former Dallas Mayor Laura Miller Madam No because of her refusal to support the building of Jerry World in her city, but this name may be more suited for health insurance companies for their denial of health claims.
It's common knowledge that thousands of health claims are denied each year, but exactly how many and for what reasons might require an act of God.
"This is one of the dark corners of the black box that is private health insurance," said Karen Pollitz, a professor at the Georgetown University Health Policy Institute. "The number is knowable, but not known by regulators or policy makers or patients."
This information is collected by insurance companies, but only California requires them to report the data to state agencies, said Pollitz.
Don't fret though, new federal rules have made it easier to fight back when your insurance company denies your claim.
The new regulations expand consumers' rights to appeal denials, including the right to an independent, external review board. Consumers can also use the appeals process when their coverage is canceled.
Previously, a patient's appeal rights varied by insurer and state. Now there's consistency in the process and the external review guarantee is extended to employees of companies that offer their own health plans without contracting with an insurance provider.
The regulations will apply to new health insurance plans starting Sept. 23.
"Until the [health care law] reform, only a select number of states honored external review," said Erin Moaratty, a spokeswoman with the Hampton, Va., nonprofit Patient Advocate Foundation (PAF), which helps patients navigate the appeals process. "Now every state is required to have a process for external appeals."
To date, external review boards have reversed about 45 percent of appealed denials, according to the Kaiser Family Foundation.
In order to successfully overturn a denial, PAF suggests you:
Keep records. Record every phone call that you have with your insurer in a notebook. Include whom you talked to, what you discussed and the date and time of the call.
Watch deadlines. Find out the appeal deadlines in your insurance contract and make them! If you miss a deadline that could mean game over for you.
Follow-up. This is the perfect time to feed steroids to the micro-manager in you. Make no assumptions. Follow-up, follow-up and follow-up some more. And if you have to mail anything to the company, go the certified route so you have proof that someone received it.
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