A weekly solution to a problem affecting your finances.
Problem: Your health plan refuses to cover a medical treatment.
Solution: Appeal the rejection. Start out by calling the insurer to see whether the problem is a simple billing or procedural mistake that can be easily corrected. If not, appeal. Most disputes center on one of two issues: whether your care is medically necessary, or whether it is something that's covered under your plan.
Either way, you'll want to secure copies of key insurance documents, including the denial letter and a full explanation of your plan's benefits, often called the "Evidence of Coverage." That will help you understand what's supposed to be paid for by your insurer. If your appeal centers on medical necessity, enlist the help of your doctor, who can write a letter explaining why you needed the treatment. You should also try to find medical studies backing your case.
Sign Up and Save
Get six months of free digital access to the Lexington Herald-Leader
For more detailed advice about filing a health-insurance appeal, try the Web sites of the Kaiser Family Foundation and the Patient Advocate Foundation.
Wall Street Journal