Hi Jen: Thanks for posting this article! A little bit of knowledge and a lot of organization can make all the difference in a successful insurance appeal. I would chime in that keeping detailed notes of phone calls (including times of phone calls, the names of everyone you speak with, and reference numbers for the call), following up in writing always, and making sure that you meet every deadline laid out in your policy can make or break the claim. As a former in-the-trenches attorney for insurance carriers and as a current advocate who handles insurance appeals and grievances, the paper trail is critical.
For private insurance, make sure to ask for a full copy of the policy. It should set forth the rights and responsibilities of an insured. If you have questions about why a claim was denied, you may wish to request a complete copy of the claim diary and notes from the adjusters who handled your file. This may give a lot of insight into the denial.
Also, your state's laws may have additional protections or requirements they have if you want to pursue the claim. For example, in Florida, our laws have notice requirements before we file lawsuits for insurer violations.
Finally, for caregivers who are handling insurance claims and appeals for someone else, it is crucial that you have the proper paperwork to speak on behalf of the insured person (for example, a Durable Power of Attorney that specifically lays out powers like "preparing, signing, filing, and appealing" Medicaid or insurance claims).
I'd love to hear input from other caregivers who have had to appeal an insurance claim for someone else. Was the denial reversed? What did you wish you knew, looking back? My post is running long, but I'd be happy to share a few stories as well.
Amanda Singleton
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