At SBCMS, we support the patient's right to access crucial healthcare services. This guide will walk you through how to file a complaint against your insurance company if you believe that your healthcare rights have been wrongly denied.
How to Fight Your Insurance Company When Coverage is Denied. Should you have to battle your health insurance company over a denial of coverage, there are steps you can take to avoid health insurance denials before they occur. And if that does not work, there are steps you can take to fight them once they do. The key is organization--having all your paperwork in order, taking detailed notes of your interactions with everyone in the process and understanding your coverage.
Information is power, and this is never truer than when battling a healthcare system. The winner may be the side with the better-organized, more-detailed information. The best bet when dealing with insurers is to minimize the risk of denial, and then if one does come your way, to solve the problem in the early stages.
You are your own best advocate. You know best what ails you and what questions and concerns you have about your treatment. Take yourself seriously--be your own advocate at all times. Here are some steps to help avoid denials of care and coverage by your health care provider before they occur:
Assuming you have taken all the above mentioned steps and are still denied coverage, do the following:
The majority of California’s health plans are regulated by either the California Department of Insurance (CDI) or the California Department of Managed Health Care (DMHC). The CDI regulates point-of-service health plans and certain Preferred Provider Organization (PPO) health plans underwritten by health insurance companies authorized by the CDI.
The CDI does not regulate Health Maintenance Organizations (HMOs) or certain PPOs, which fall under the Knox-Keene Act (i.e. Blue Cross of California or Blue Shield of California).
For a list of health insurance companies regulated by the Department of Insurance, visit their website at www.insurance.ca.gov. For a list of the HMOs and other healthcare service plans regulated by the Department of Managed Health Care, please visit the DMHC website at www.dmhc.ca.gov