How to Fight Health Insurance Denials

Reader Comments
Back to blog

I HAVE HAD A PROBLEM FOR 31 YEARS. ALL MY LIFE. 50+ DOCTORS AND HUNDREDS OF THOUSAND OF DOLLARS IN WASTED INSURANCE PREMIUMS, EVEN MORE IN MEDS, 10 HOSPITALS AND 5 OPERATIONS..MY PATHETIC FLY BY NIGHT, BLOOD SUCKING WHORE HOUSE, MAQUERADING AS AN INSURANCE CO........HAS DECIDED THAT EVEN THOUGH THE 1ST OP WAS BOTHCED AND THE 2ND WAS DAMAGED BY A SCOPE, AND NOW THAT I HAVE GONE THRU 6MOS OF PREP, I CAN"T GET THE FIX FOR EITHER........THE PUNCHLINE IS.....THEY DID NOT PAY FOR EITHER, THEY WERE NOT EVEN IN BUSINESS FOR THE FIRST, AND THEYCOULD NOT EVEN BE BOTHERED TO ASK ME ONE SINGLE QUESTION DURING A RECENT CONFERENCE CALL.......I AM LUCKY, MY PARENTS HAD EXCELENT INSURANCE WHEN I WAS BORN(A 10 DAY STAY) FOR ME AND MY MOM.....27GRAND IN 1979!.....PROJECTILE VOMITING,AGE 2....ASTHMA(25 HOSPITAL STAYS),STEROIDS AND ANTIBIOTICS ALL MY LIFE, ALLERGY SHOTS( 3 ANAPHALACTIC SHOCK),CELIAC SPRU(GAS BLOT SYNDROME), DIVERTICULITIS, 7/8 SPORTS INJURIES, DEPRESSION(3 SHORT STAYS)AND SO ON AND SO ON.......THIS COMPANY NEVER PAID FOR ANY OF THESE...... UNFORTUNATELY FOR THEM.....PRUDENTIAL,BC/BS,UPMC GATEWAY, STATE OF PA. CHIPS, AND OTHERS KEPT ME ALIVE JUST SO THESE IDIOTS COULD SCREW ME......I AGED OUT OF AETNA @23 PAYING 1500 PER MO W/MY MOMS COBRA....TO SAVE MY MOM DROPPED HERS AND PAID 900 FOR ME. OUT OF SCHOOL MY JOB GAVE ME OXFORD???? AND NOW THIS. THIS TINY SUBSIDIARY OF A BIGGER VULTURE, CIGNA SAYS THAT I CAN ONLY HAVE THIS SURGERY ONCE IN A LIFE TIME.......R U F@!#$%%#@@ KIDDING ME.!!!!!!!!!!!!!!!!!
WHAT GIVES THEM THE RIGHT TO TELL ME WHAT I CAN AND CANNOT HAVE OR NEED??????? THEY HAVE NEVER EVEN SPOKEN TO ME OR PAID A BILL AND THEY LET ME GO THRU PREP FOR 6 MOS AND THEN DENIED A WEEK BEFORE THE SURGERY..........THEY ARE HOLDING ME, MY SOUSE, MY EMPLOYER AND MY CO WORKERS HOSTAGE. HOW CAN IT BE THAT I WORK A 60 HR WK PAY LARGE PREMIUMS AND I HAVE TO DEAL WITH THIS?
WORSE THAN THAT I WORK A JOB AND RUN A BUSINESS(PROFITABLE) THESE BASTARDS AND THEIR LOBBIEST HAVE FIXED IT SO I CANT GO ELSE WHERE AS AN SMALL BUSINESS OWNER AND BUY ANOTHER POLICY. NO DEDUCTION ON A BECAUSE I DON'T REACH 7.5% AGI AND NO ADJUSTMENT ON 1040 BE CAUSE OF EMP COVERAGE..........A FINE CUP OF TEA!

LORRI of PA 12:40AM April 13, 2010

My good friend has a 9 year old who has had no hearing in his left ear since birth. There is a surgery that the doctors are wanting to do now that will restore 90-100% of his hearing! It's a miracle they've waited for....their insurance company has denied the doctor's letter, the parent's letter, and the family is currently waiting on another appeal they sent, that is considered "personal." After that, they don't know what to do. The surgery is %30,000, and the company won't cover any of it. Any thoughts/suggestions for them???
Thanks, Laura

Laura of OH 12:06PM April 07, 2010

Good article.
There is another online tool for health insurance denials, and managing them as a patient. It is http://www.healthharbor.com/health-insurance-101/denial-analyzer.
Choose the denial you have, and you can get an idea of how to deal with it. As a patient fighting the insurance company, you need all the tools you can get.

John of MD 3:01PM October 05, 2009

Quit believing the lies originated and perpetuated by the insurance companies - we need single payer now! EVERY developed country in the world EXCEPT us has single payer health care. It is good for the economy and it is good for the people. The only ones it isn't good for are insurance companies. They are interested in ONE thing, NOT paying claims. Every claim they don't pay adds to the obscene profits they bring home.
It is nothing more than pure common sense.
Do not believe the lies about Canadian health care - they are ALL lies. Do not believe the lies. You are feeding into the profit motive of U.S. insurance companies. Get smart and do REAL research, not talking head research and not lobbyists paid for research.

Cheryl Fontaine of WA 9:57AM September 16, 2009

I had to make two trips to the Mayo Clinic in Minnesota and fully a third of the cars in the parking garage had Canadian plates on them-and you want the same government health plan as Canada has?? Where is your head!! Canadians are praying Obama Care falls flat or they will not have any place to go and will have to wait past death for treatment-if it is aproved. The government can't run anything else, what makes you think they can run health care? Fix what is broke in the present system.

Carol J Lyon of MI 9:58PM September 15, 2009

I bet it was a "great day" when insurance companies signed up to cover us and make us well. Well, things have changed and the CEO salaries are over the TOP... http://sickforprofit.com/ceos/
I fight all "denials" from the "Dr. Zeus", who never met me, never saw my condition, nor reviewed the tests of same. I'm certainly NOT in favor of a "FOR PROFIT" insurance company!
With that said, I'm not going to PRESUME that a government run health system to compete with the "aforementioned", will be good or bad UNTIL we have the opportunity to experience it ! Where do people "get off" with all these negative presumptions? Huh? Negative and untrusting attitudes will never result in any kind of progress, whether it be what we like, versus what we don't.
Let's give our ideas a run for it?

Roger A. Rankin of CA 12:51PM September 15, 2009

You are correct. It is the doctor that determines what is necessary and what is not. If it is "optional", then you doctor needs to tell you that and ask you if you still want it done. And furthermore, if the insurance company goes ahead and pays it, and then later comes back after one of their internal audits and says they want an overpayment payed back to them, DO NOT DO IT! I had this happen and the insurance company will do everything including sending your case to their collection agency. Don't repay the overpayment! Fight them!
When it comes to the state insurance office for complaints, forget it. In Michigan they tell you its a 6 week process. My last one filed this year in January took 6 MONTHS! And then, even though they admitted I was right, they said there was not enough specifics in the law to hold the insurance company accountable. This office is worthless in my estimation. Go ahead and try it if you want, but I think you are far better off fighting insurance companies yourself. Wait them out, don't get impatient. One of my fights several years ago took 2 years, but I finally won.

Jeff of MI 12:45PM September 15, 2009

Marl, you lie like a rug. Vets are happy to have healthcare benefits from the VA. They don't have to argue when it comes to getting eye exams or drugs. My cousin donated free optometric services for 4 months in a VA hospital in Columbus...nothing but appreciation was expressed by every vet that she met.
No wonder Cleveland is doing so badly...they've got idiots like you.

Max of OH 12:23PM September 15, 2009

I work insurance denials for the physicians in a major hospital. If a physician performs a test or procedure on a patient that the insurance company denies as not medically necessary, the patient IS NOT responsible for the charges. You are not required to know what is medically necessary and what is not - you leave that decision up to the physician, and if he performs a test or procedure that is not medically necessary (as deemed by your insurance company), that is his choice and his responsibility. He (or she) can fight it out with the insurance company in order to get paid, but you are not responsible!

diane of AR 12:16PM September 15, 2009

I'd rather fight with an insurance company than to go against a federal bureaucrat. That's what Obama's plan will do for us. If you think the insurance companies are stingy, just wait until the government gets into it . . .have you ever hears about the VA and the problem our veterans have getting basic humaine care?
Public Heath Plan Option
Go President Obama. This posting and the comments are exactly why we should have a single nationalized health plan. The insurance companies deserve to be put out of business. They are simply evil money thieves.

Marl in cleveland of OH 11:46AM September 15, 2009