What to do if your insurance claim is denied

Reported by Casey Roman - blog|email
Posted by Debra Worley - email

WILMINGTON, NC (WECT) - Even people with health insurance are going broke trying to pay medical bills.

New Hanover Regional Medical Center said they're seeing insurance companies deny more and more of their patients' claims.

Phyllis Benson has been fighting on two fronts for years - one against lymphoma, the other against her health insurance company Humana, who has denied payment on many of her cancer treatments.

The number of denied claim letters began to grow when her cancer started to spread.

"If it had gone to my bones I would have had to have immediate treatment or die," said Benson.

Benson's doctor sent her for an MRI, but Humana sent a bill and denied the claim saying it was an unnecessary treatment.

It turns out Benson isn't the only patient being denied claims.

Data on hospital stays at New Hanover Regional Medical Center shows an increase in denied claims, which they say is causing patients to just stay away.

"What's happening is, they're not seeking health care so now they're ending up in our emergency department or doctors office sicker than maybe they would have been if they had come at the first sign of the problem," said NHRMC Chief Nurse Executive Mary Ellen.

But Benson wasn't willing to get sick or give up, so she wrote Humana repeatedly, appealing the denials.  Humana responded months later saying it was a mistake.

Pat Payne, the CEO of Medical Insurance Assistance, Inc., has been a patient advocate for decades.  She advises patients to know your plan and be sure you are covered for what you're claiming.

Payne also said to have your claim resubmitted with your medical records to show why you needed treatment.  She says to also call your insurance company and request a case manager and an outside physician to review your claim.

If those options don't work and you are, in fact, covered for what you're claiming, contact the State Department of Insurance for an external review or to file a complaint.

For more information visit the WECT Investigates blog.

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