If you are being treated for anxiety, health denied insurance is all too common. This type of claim can be difficult to get funded, even when your insurance policy states that you have coverage for mental health issues.
Anxiety and Insurance Coverage
The problem with getting coverage for mental health issues like anxiety is that there is no definitive diagnostic test that can determine whether someone has an anxiety disorder. The doctor has to rely on the patient's narrative account of his or her symptoms to make a diagnosis. The insurance company may resort to anxiety health denied insurance tactic to avoid paying out on the claim.
Appealing An Anxiety Health Denied Insurance Claim
If your claim for benefits for an anxiety-related disorder is denied, you have some options available. Insurance companies know that many people who have a claim denied don't take it any further. You do have the right to appeal the insurance company's decision if you believe that you are being denied benefits that you are entitled to under the terms of your health insurance policy.
Get The Reason In Writing
Your first step in appealing your insurance company's decision is to ask the company to provide you with its reason for denying your claim. You have the right to receive this information in a written form. Once you receive the reason for the denial from your insurance company, check the language in your policy to confirm your understanding that the anxiety-related health care services should have been covered.
Ask Your Doctor For Help
If you believe that the insurance company made its decision to deny your coverage based on incorrect information, ask your doctor to prepare a report for your insurer outlining the following:
- The treatment prescribed
- Whether the treatment was recommended for the patient's well-being
- Assurance that the treatment was an appropriate response, based on the patient's medical condition
Ask Your Insurer To Reconsider
Armed with the appropriate policy language and the report from your doctor, you can write a letter to your insurance company sharing this information with them and asking that your file be reviewed again. If the answer is that your claim is denied, the insurance company should notify you of your right to appeal and explain the procedure for doing so. The company probably has a time limit for policyholders to launch an appeal. If you choose to take this step, you should start the process shortly after your claim is denied. You may have 60 days or less to launch your appeal, and once the time limit has expired you lose your right to do so.
Keep Detailed Records
From the time your initial claim is denied, you should keep detailed records. If you speak to a representative on the phone, make a point of getting the name of the person you talk to (first and last name). Record the date of your conversation and write down what you discussed and what action, if any, the insurance company agreed to take on your behalf. It is also a good idea to send the insurance company a letter confirming what you discussed. Send it by registered mail so that you have a record of the fact that you mailed it and that the insurance company received your correspondence.
Going Outside the Company
If you have gone through the appeal process with your insurance company and your claim is still being denied, you can take the matter to regulatory body in your state. To get more information about how to launch an appeal at this level, contact the Department of Insurance within your state for help. If the department decides in your favor, the insurance company will be required to pay your claim.