An Insurance Denial is Not the Final Word, or…Why You Should Always Appeal an Insurance Benefit Denial

If you are submitting a claim or appeal for health benefits or disability benefits, you can find inspiration from some determined individuals whose diligence and preparation got their claims paid:

– Wayne Harris was diagnosed with ALS (Lou Gehrig’s Disease) in 2010. When Mr. Harris required additional adaptions to his home to suit his physical needs, he did not accept the insurance company’s denial: “Instead of accepting his insurance company’s denial for his request for a lift system to get him out of his power wheelchair and into a bath tub, he studied the reasons for the denial, then carefully detailed his needs. He received documentation from medical professionals that justified and verified the necessity for the lift equipment, which enables him to bathe in his own home.”
http://www.alsa.org/news/public-awareness/als-awareness-month/2012/wayne-harris.html

– Maria Carr was denied health benefits by United Health for arthroscopic surgery to treat a bone spur on her hip. Ms. Carr “researched medical journals and other publications to find proof that her procedure was a bona fide and safe treatment. She then wrote a formal letter to her insurer making her case and including copies of the research she had found. Her doctor backed her up with a thorough letter of his own. The appeal was initially denied, but Ms. Carr kept fighting. She took her case to her insurer’s external review board, where an impartial medical expert weighed the evidence. The expert agreed with Ms. Carr, saying UnitedHealth had to pay the claim.”
http://www.nytimes.com/2010/02/06/health/06patient.html?pagewanted=all&_r=0

– Jennifer C. Jaff required a certain drug prescribed by her doctor to treat her Crohn’s disease. “Her insurer argued that other, more established drugs could treat the problem. True enough, but Ms. Jaff had already tried those drugs without success. For her appeal, Ms. Jaff collected her medical records that showed when she had tried each drug and how each had failed. The strategy worked, and her claim was ultimately paid.”
http://www.nytimes.com/2010/02/06/health/06patient.html?pagewanted=all&_r=0

A denial by your insurance company is not the final word. With a little advocacy, research, and determination, you will have the tools to fight for the health benefits to which you are entitled.

For some, it might be possible to overturn a denial without legal assistance. If a case becomes too complex to manage on your own, you may want to consider seeking assistance from a reputable professional.

For help with a long-term disability insurance claim, call us at (800) 446-7529.

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