Being Your Own Advocate: What to Do When Insurance Denies Your Claim

There’s nothing worse than getting a nasty surprise from your health insurance company. It’s easy to assume that procedures and treatments will be covered. But when those assumptions prove incorrect and the bill comes due, it can cause financial havoc for you and your family. There are also many issues with senior citizens, who often do not understand what benefits they are entitled to through Medicare, especially in relation to long-term care.

Many people automatically bite the bullet because they are unaware that they have the right to question or appeal charges or request extensions. Unfortunately, in many cases, the procedures that are appealed or questioned simply aren’t covered, including many dental services for adults, weight-loss surgery, fertility treatments, and many others. It’s usually simple enough to find out in advance about a procedure you’re planning; however, many patients don’t think to investigate, or simply find the process too confusing. If you’ve been denied, you should always follow up by calling customer service or a dedicated customer complaint number. If you’re left holding the bag, MedBiz Pro wants you to know which options are available to you.

Financing alternatives

Medical practices are in business to make money. As such, they may be in a position to help you find financing options for a procedure that isn’t covered by your insurance. You may be able to work something out with the practice, or your doctor might have financing arrangements with other sources. Bear in mind that private medical practices have more leeway when it comes to payment and financing than practices that are affiliated with hospitals, which means there may be room for negotiating a settlement or arranging a payment plan. For many people, this is the only way to keep from going into collections or incurring legal problems. Don’t forget to keep notes and records from meetings with your doctor that could come in handy if you file an appeal, or if matters escalate even further.

Loans vs. credit cards

Patients often assume that paying for unexpected health care costs with a medical credit card is the best option, allowing them to stretch out payments and handle the debt in their own time. However, people are often misinformed or mistaken as to how this works, failing to understand that high interest rates (20 percent or more in many cases) can put you in a real bind. As with any credit card, you should always read the contract and consider how long it will take you to pay off the balance. In many cases, you may have access to a loan that’s specific to the treatment and makes more sense than a credit card.

Free Up Cash

If your medical bills are taking a toll on your bank account, it’s important to find ways to free up cash. This starts with limiting your expenditures, and forgoing things like dining out, impulse purchases, unnecessary subscriptions and the like. To get a clear picture of what you can afford, it’s wise to revise your budget accordingly so that you can get a handle on payments. In the event that your medical bills prove to be enough of a hardship and you start to fall behind on home loan payments, you can talk to your lender about a loan modification. This is a permanent solution your lender can offer to help lower your payment; however, you’ll have to prove your financial hardship in order to be eligible. Remember, if you’re in danger of default, don’t ignore your lender! Reach out to find a way to stay in your home.


There are many companies that offer advocacy services for people who are in conflict over uncovered medical bills.  In fact, this may be the best option for many patients who have run out of alternatives. Billing advocacy companies will comb through medical bills to try and find errors you would never catch, not knowing what to look for. In some cases, they can even help you negotiate reduced payments.

Be persistent

No matter what happens, your best option is always to try and get your health care insurance provider to help with the cost. That means appealing your denial, a drawn-out and frustrating process that requires a great deal of determination. However, the benefits are well worth the effort if you’re successful. Don’t forget that it’s a policy among many companies to deny all claims the first time to see if patients are willing to comply. Be sure to follow up!

Remember that you are your best advocate when it comes to challenging insurance decisions. The worst thing you can do is blindly accept an insurer’s decision without investigating, challenging, appealing, etc. It’s too easy to forget that you have rights, too.

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