New regulations to help fight back against denied health insurance claims

New regulations are going into affect beginning September 23, 2010 that can help you fight back when the insurance company denies your claim. The new regulations expand consumer right to appeal denials.

The new regulations create  consistency in the appeals process and extend an external review guarantee to employees of companies that offer their own health insurance plans. This can be done without contracting with an insurance provider.

Previously patient’s rights have varied from state to state and by insurer. “Until the [health care law] reform, only a select number of states honored external review,” says Erin Moaratty, a spokeswoman with the Hampton, Va., nonprofit Patient Advocate Foundation (PAF), which helps patients navigate the appeals process. “Now every state is required to have a process for external appeals.”

In order to be able to overturn a denial, consumers must keep track of paperwork and phone calls. The three most important tips are:

Watch deadlines: Deadlines are spelled out in insurance contracts regarding appeals. If you miss the deadline, it may be impossible to file an appeal.

Keep records: Place records in a folder or a binder and carefully write down the date of each call to your insurer, who you talked to and what you discussed.

Follow up: Send correspondence by certified mail so that you will have a receipt. Don’t assume something is being done just because you called or sent a fax.