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Try These Strategies if Your Medical Bill Has Been Denied by Insurance

Do you have medical bills that your insurance company doesn’t want to pay? You have several options as you explore different ways to pay the bills.

If your insurance company won’t pay the bill, consider these ideas:

  1. Understand the out-of-network rules. Receiving care out-of-network is one of the most common reasons an insurance company denies payment.
    • Did you go to a hospital, clinic, or doctor who is outside of your network? Insurance companies have strict rules for what they will cover. They may not want to pay for hospitals or doctors who aren’t part of their network.
    • Unless you had an emergency that couldn’t be treated at an in-network provider, you may not be able to get the insurance company to pay.
    • Your city or state may have specific rules that can force insurance companies to pay for out-of-network services in emergency situations. However, you may still be responsible for some of the charges.
  2. Negotiate your payment. If your insurance company won’t budge on the medical bills, you can try to negotiate a payment with the hospital or doctor.
    • Depending on your financial circumstances, you may be able to get a discount or payment plan to help you. You may also qualify for a grant, financial assistance, or other program.
  3. Consider contacting local charities. If your medical bills are extremely high and you can’t pay them, a local charity might be able to help.
    • Local charities may have ideas for helping you raise the money. They may have fundraisers or grants that can assist you with the bills.
  4. Check for mistakes. It’s possible that an error prevented your insurance company from paying the medical bills. It’s important to double check the actual bills and contact the medical provider for help.
    • Hospitals and doctors sometimes make billing mistakes. They may bill the wrong insurance company or send the wrong codes.
    • You may want to contact both the doctor and insurance company multiple times if you have questions about the bills. You have to become your own advocate and try to get the bills covered.
  5. File an official dispute. Your insurance company should have an official dispute process. It may take a mountain of paperwork and an ocean of phone calls, but you can handle the dispute process.
    • Documentation is the key to winning a dispute. Keep careful records and make multiple copies of each medical document. Find policy and state rules that back up your claims.
  6. Make phone calls and write letters. Experts recommend doing both for the maximum effect and response rate.
    • Phone calls may not be enough to get the attention of your insurance company.
    • You may have to write letters or send faxes to document your issues. This will create an important paper trail that can help your case.
  7. Consider getting a medical billing advocate. These advocates can charge fees, but they can also help you negotiate your bills and deal with insurance. If you have large medical bills, then it may be worth the fee to get professional help.
    • Medical billing advocates are trained to help you pay the smallest amount possible on your medical bills.
    • They know the negotiation tactics that work on hospitals, doctors, and insurance companies. They can handle the massive paperwork and calls that are required to accomplish your goals. 

Insurance companies can deny payment for a variety of reasons.However, you have rights. Before you pull out your checkbook, you may want to explore different ways to handle the medical bills. Perhaps you can get them paid or reduced for your time and trouble.

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