Consumers have formal and informal options that often require a healthy dose of patience — whether waiting on hold or wading through lengthy health plan documents.
Medical billing and health insurance systems in the U.S. are complex, and many patients have difficulty navigating them. Your doctor says you need an expensive treatment, but your health insurer says they’re not going to pay.
It’s not clear how often consumers confront this dreaded scenario. When it happens, patient advocates say you shouldn’t always accept the health plan’s coverage denial as the final word.
They recommend asking insurers and health care providers two questions: Why is the service not being covered? And can the decision be reversed?
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