WHAT YOU SHOULD DO IF YOUR INSURANCE WON’T PAY YOUR MEDICAL BILLSLast updated on: October 17, 2022
The action you should take if your insurance company does not pay your medical bill depends upon the reason the insurance company gives for not paying. It might claim that certain services are not covered or that your claim was not filed correctly.
WHAT DO I DO WHEN MY HEALTH INSURANCE DENIES PAYMENT?
Fortunately, you have the right to appeal the insurance company’s decision and have a third party review your claim and the decision. The insurance company must let you know not only the reason your claim was denied but also how to challenge the insurance company’s decision.
You can appeal the decision internally by having the insurance company review its own decision. Alternatively, you can appeal independently to a third party through an external review, which takes some decision-making power away from the insurance company.
MAKE SURE THE CLAIM WAS PROPERLY CODED AND SUBMITTED
Policyholders do not usually submit claims to their insurers. Rather, hospitals and healthcare organizations submit the claims for their patients. If you remain within the correct provider network, your healthcare provider, health center, or hospital will take care of the claim filing procedure.
Those healthcare facilities will also usually manage the precertification/prior authorization process, which helps prevent your claim from being denied. However, there is still room for error. For example, the claim could be inaccurate, or the billing codes could be contradictory.
If your claim was denied and your insurance company informs you that you must pay, ensure that you completely understand why you are not covered before you pay anything. Check with your doctor’s office and your insurance company and have them explain the denial to you.
If you receive healthcare outside of your insurance company’s network, familiarize yourself with your insurance plan’s requirements for filing out of network. You might have to pay your bill upfront and be only partially compensated by your insurance company after the fact. You may also have to file the claim yourself.
CONTACT THE INSURANCE COMPANY DIRECTLY
Your insurance agent is generally your first contact to help resolve issues with your claim. If he or she fails to help after thirty days, call your insurance company yourself. Keep track of each person you speak with, starting with the person who denied your claim.
Take notes from your phone call and any follow-up calls. After each call, send the company a letter by registered mail describing your interpretation of the conversation. Keep copies of your letters and the receipts from the registered mail and try to remain polite in all of your correspondence with the company.
UNDERSTAND OUT-OF-POCKET REQUIREMENTS
A denial is not the same as paying out-of-pocket fees. For example, you might undergo a procedure for which you must pay out of pocket, but that procedure might still count towards your deductible. Therefore, your claim was covered and not denied—you simply have to pay the full amount of your deductible before your insurance pays for medical services.
WHAT SHOULD I DO IF I CAN’T PAY MY MEDICAL BILLS?
If there has not been an error in denying your claim or if you must pay out-of-pocket costs, you still could have options to help cover your medical bills. Hospitals that have a 501(c)(3) nonprofit status must give free or discounted care to patients who cannot afford to pay their medical bills.
If you are an older adult covered by the Qualified Medicare Beneficiary program, then your healthcare provider should not bill you for anything covered by Medicare. If your healthcare provider tries to bill you for deductibles, coinsurance, and copayments covered by Medicare, call Medicare and explain your situation. The provider should stop billing you and pay you back for any unnecessary payments you made.
If you are a veteran, you could receive financial hardship assistance to help you pay your medical bills. Write to your local VA medical center about your billing dispute to learn about your options. Find your local VA medical center here.
MEDICAL DEBT IS MORE COMMON THAN YOU THINK
You might feel alone in your medical debt, but it is far more common than you might think. In 2020, 17.8 percent of people with a credit score had medical debt, and the average amount of medical debt was $2,424.
However, you should not take on medical debt if your insurance should have covered your claim. On the other hand, if there is no way around your medical debt, you still have rights regarding debt collection.
KNOW THE LIMITS ON DEBT COLLECTORS CONTACTING YOU
If you are in debt, your healthcare provider will probably hire a debt collection agency, which sometimes consist of attorneys, to call you and attempt to collect the debt. These debt collectors may not say whatever they want to you, and they must follow specific rules while contacting you.
For example, collectors must keep things civil. They cannot threaten harm against you, curse at you, or harass you by calling you repeatedly. They cannot charge you more than you owe or openly expose your debts to the public.
Additionally, collectors may not lie to you. They cannot claim to represent the government, and they cannot pretend to be a lawyer if they are not one. They may not falsely tell you that you will be arrested if you do not pay.
Debt collectors can only contact you between the hours of 8 a.m. and 9 p.m., unless you give them permission to call outside those hours. They cannot call you at work if you have stated that you cannot accept calls while at work. Be wary of scam debt collectors.
KNOW YOUR RIGHTS AND PROTECTIONS WHEN IT COMES TO MEDICAL BILLS AND COLLECTIONS
Following the checklist of steps in this article can give you peace of mind when dealing with the financial burden of medical bills on top of all the stress of recovery.
- Check your bills for accuracy
- Learn about your financial assistance options
- Beware of debt collection scams
- Know your protections under the No Surprises Act
- Submit a complaint when your medical provider or insurance company violates your rights
If you still have questions about your medical bills and collections, speak with an attorney at Zinda Law Group today.
NEGOTIATE YOUR BILL
It may surprise you, but you can try to negotiate your bill to a more affordable amount.
To do this, start by trying to set up an interest-free payment plan. Also, try to avoid using credit cards to pay your bill, since they can have high interest rates and make you lose your ability to negotiate.
GET OUTSIDE HELP
Seek help if you are unable to afford your medical bills. If your state has a Consumer Assistance Program, you can receive valuable advice and direction.
The No Surprises Act protects you from surprise medical bills. A surprise medical bill can occur when you receive treatment from a healthcare provider that you did not realize was out of network. If you received a surprise medical bill and your claim was denied, you should appeal the claim.
As mentioned earlier, you could be eligible for help through Medicare. In addition, you can access the Centers for Medicare & Medicaid Service’s website to learn about your rights, submit a complaint about medical billing, or start a payment dispute. You might also be able to get help from your state attorney general or state insurance department.
YOUR STATE INSURANCE DEPARTMENT MAY BE ABLE TO HELP YOU
Your state Insurance Commissioner supervises state insurance products. Contact the Insurance Commissioner’s office and explain what has happened to you.
However, if you are self-insured through your employer, the state Insurance Commissioner might not be able to help you directly but can point you in the right direction.
YOUR RIGHT TO APPEAL A DENIED CLAIM IS PROTECTED
The Affordable Care Act protects your right to appeal your claim so long as your healthcare plan is not grandfathered. Remember that you can use an internal appeal and an external review.
If you have questions about appealing your claim, talk with an experienced Zinda Law Group attorney who can help.
NEED HELP? CONTACT ZINDA LAW GROUP TODAY
If you or a loved one has been denied payment from an insurance company, call the Zinda Law Group at (888) 400-6637 for a free consultation.