How to Respond to an Insurance Denial When You're Fighting for Your Life

Posted By Rachel Teicher || 9-Apr-2015

When seeking treatment for an eating disorder, making the decision to fight for your life can be a dreadful and terrifying task. Add on fighting with your insurance company, and the pressure and stress can quickly escalate. If you receive an insurance denial for the treatment of your eating disorder, do not give up here! The road might be complicated, but you have the power and tools necessary to respond efficiently and appropriately. You have the ability to fight back and advocate for the insurance benefits to which you are entitled. You have the power to fight for your recovery.

Dealing with an insurance denial can often feel overwhelming, and might even feel impossible. Follow our tips below for guidance. If things become too complex to manage on your own, you may want to consider seeking assistance from a reputable professional. Kantor & Kantor offers no-cost consultations and is happy to provide additional support. In the meantime, empower yourself with knowledge and continue to fight on your path to recovery.

  1. Don't freak out! Receiving an insurance denial for the treatment of your eating disorder can be incredibly frustrating and complicated; however, an insurance denial is not the final word. Remain calm and map out your plan.
  2. The plan.
    • Request a copy of your insurance policy. Without it, you do not know the rules. You can get this from your employer or through the insurance company.
    • Stay in treatment, and follow the recommendations of your treatment team. Do not let the insurance company dictate your treatment plan.
    • Keep records of all out-of-pocket expenses for future reimbursement.
    • Document everything. Document what forms of therapy and treatment you have exhausted by submitting copies of all treatment records to the insurance company. Document that the treatment is medically necessary by providing your doctor's written support, your own letter describing your need for treatment, and if available, letters of support from family members or co-workers. Make sure that your treatment facility documents all communication with the insurance company in writing, and retains records of correspondence.
  3. Appealing the Decision. Your appeal letter should read like a cover letter to your insurance company. When writing an appeal letter, refer to the evidence and documents enclosed in your appeal packet, and indicate why this information should change their mind. Although appeal letters vary in style, the format of your letter should include the following:
    • Simply state that you are appealing the decision.
    • Explain why you disagree with the decision.
    • Provide support for your claim. Take this opportunity to explain the history of your eating disorder, (including documentation of all forms of therapy and treatment that you have tried) and the full impact that your eating disorder has had on your life. In your letter, consider including:
  • Summaries of any prior letters or documents
  • Point out the inconsistencies in your insurer's decision
  • Point out the irregularities in your insurer's decision
  • Point out the omissions in your insurer's decision
  • Enclose any new documents
  • Include copies of all medical records
  • Include written support from your providers, family, and friends, and co-workers. Letters from doctors, clinicians, treatment teams, and family members can be a powerful way to display the medical necessity of the treatment for your eating disorder.

4. Don't give up. Your insurance company is counting on you to give up and give in. Keep your focus on careful documentation, timely appeals, and of course staying in treatment for RECOVERY. Lean on family, friends, and your treatment team for support during this stressful time. Please remember that an insurance denial is not the final word, it is simply a hitch in the plan. You have the tools to fight on and continue walking towards recovery.

If you have experienced an insurance denial for the treatment of your eating disorder, please do not hesitate to contact Kantor & Kantor, LLP for support.

We understand, and we can help.

www.kantorlaw.net (800) 446-7529

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