INSURANCE

Q: My medical claim was denied. What should I do?

A: Having a claim denied is frustrating and often very frightening, but this is not the time to immediately reach for your checkbook. There are steps you can take before you do that.

The first person you should turn to is your agent. As an agent, I work with insurance companies every day so I know who to contact regardless of how complicated my customers’ issues may be. It is part of my responsibilities as an agent.

If you do not have an agent, here is what I suggest:

1. Organize all pertinent documents including your insurance card, your Medicare card (if you are on Original Medicare), your billing statements and Summary of Benefits. Cross check all the information to make sure there are no clerical errors and all the information is correct. Familiarize yourself with your plan, including your co-pays, cost of visits for specialists and out of pocket maximums.

2. Set up a notebook specifically for your medical treatments and insurance issues. Whenever you call anyone related to your claim, note the name of the person you spoke with and what they advised so you have this information to refer to on any future calls.

3. If the insurance company representative promises to get back to you with answers, ask for a date. Note their name, phone number and follow-up date in your notebook and be prepared to follow up with them.

4. If the insurance company agrees to make an exception of any kind, ask for that agreement in writing.

5. If you are calling for another person, be ready to have them get on the phone to let the insurance company know it is okay for you speak on their behalf. If you will be routinely handling someone’s insurance matters, ask how you can become the ongoing representative of that person.

6. If your claim is denied a second time, ask for the steps to take your appeal to the next level. Remember, patience and persistence will be required in order to get complex insurance matters resolved. But it can be done.

Got questions on life, health, Medicare Advantage Plans or Medicare Supplements? I will help you find a plan that works for you. Email me at Lmutsko@mutskoinsurance.com or call 440-255-5700 to set up an appointment.

Laura Mutsko Mutsko Insurance Services, LLC 6982 Spinach Drive, Mentor, OH 44060 440-255-5700 www.mutskoinsurance.com