My Health Insurance WA

Despite many consumers paying insurance premiums faithfully for years, insurance companies regularly deny claims. How do you know if the claim was denied correctly? How do you know if you should fight? And, if so, who do you fight and how?

Luckily, when you are a client of My Health Insurance of Washington we help you every step of the way. We know the insurance company games, and we know who to call on your behalf.

Below are some helpful hints to help you understand the appeal process:

1. Call Us: At My Health Insurance of Washington our goal is to get you the maximum value out of your health insurance. Many times we will know the answer to your denied claim right away. Often we can save you the frustration sitting on hold with the insurance company, only to get passed from one person to the next.
2. Appeal the claim: The denial may have been caused by human error, which does occur as insurance companies and medical providers are overwhelmed with paperwork. Each insurance company has its own appeals process, the details of which are in your contract. Don’t worry, we already know all about your policy!
3. Get medical help: from your own doctor. Your doctor can provide the evidence required by the insurance company proving that the care you received was a medical necessity.
4. Keep records: Record all correspondence between you and your insurance company. For telephone conversations, write down the name of the person you spoke with, the date and time, and confirm the important parts of the conversation. Follow up with #5 below.
5. Put it in writing: Mail a complaint to the insurance company headquarters, to every name you have on file, to the president of the insurance company, and to the head of the customer service department. All correspondence should be sent by certified mail to confirm receipt. Include copies of all relevant supporting documentation.
6. Contact the authorities: When the former attempts fail, file a formal complaint with The Washington State Office of the Insurance Commissioner www.insurance.wa.gov
7. Negotiate the bill: You ask for discounts when shopping for new cars and appliances, and you can ask for a discount from your medical doctor or hospital. If the insurance doesn’t cover a procedure, ask whether or not payment in cash would warrant a discount, or if you can make regular payments over time.
8. When all else fails - Get a lawyer: An attorney with medical insurance and appeals experience, who focuses in health law would be your best option. Hiring a lawyer is not a cheap proposition, but it can be significantly less expensive than laying out hundreds of thousands of dollars for medical care you have been wrongly denied.