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How To Maximize Use Of A POS Health Insurance Policy

Don't Accept A "No" From The Insurance Company

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Fight for a "yes." Studies show that persistence pays off.

Follow the insurance company's appeal process. Pay close attention to the dates set by the insurance company by which various actions must be taken.

  • For policies issued before September 23, 2010: you likely have a right to an internal and and external appeal. If you policy does not mention external appeals, check the law of your state. You can find the law by contacting your insurance department. Contact information is available at offsite link
  • For policies issued on or After September 23, 2010: Thanks to Health Reform 2010, you have the right to both an internal appeal and an external appeal to an independent reviewer.

To learn about time tested arguments to use, see Arguments To Use Against An Insurer's Denial Of A Health Claim.

Get help for the fight if you need to. Consider:

  • If there is a case manager, ask what he or she can do to help.
  • Getting the help of an experienced insurance attorney.
  • Using all sources of influence. For example, if you have your insurance through your employer, ask the person at the company who deals with insurance matters to speak with the insurance company.
  • Speak with your disease specific nonprofit organization. Perhaps they have information that could be useful.
  • Consider applying public pressure via television, radio, newspapers and/or the internet.

Ultimately you can complain to the state insurance department. It supervises all insurance companies which sell insurance in your state. You can find the contact information for your insurance department at offsite link.

You can also start a civil action in the courts.

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