Insurance Advocacy in a Nutshell: Getting Your Eating Disorder Insurance Claim Paid

Posted By Rachel Teicher || 11-Jun-2015

There are countless barriers and obstacles to beginning and completing an eating disorder recovery journey. For some, the recovery process can be a constant and unfinished work. A continuous motion. A conscious effort. Our friend and colleague Shannon Cutts spoke on this concept beautifully, “If we want to win the war against Ed, we need to know two things: 1) we are in a war, and 2) we can WIN it!”

One obstacle to eating disorder recovery is one that should not even exist. One that our office is quite familiar with. One that drags us in to fight another kind of war: the war against insurance companies. Every single day insurance companies make life and death decisions about people they have never met. Without specialized training or expert knowledge in eating disorders, insurance companies make medical and mental health decisions, and often impede recovery from the start. Sometimes insurers will approve coverage initially, but then end coverage long before the patient is healed.

What can you do to prevent these types of insurance obstacles? First, become knowledgeable about your rights and be prepared to advocate. If someone you know needs help during the recovery process, advocate for them! This can be an incredibly stressful time, and dealing with insurance issues on top of recovery can be overwhelming. Second, we have outlined some tips for you on how to get your eating disorder insurance claim paid. Use them, and know that we stand with you in the war against eating disorders as well as the war against insurance denials. Together we can beat this.

1. STAY IN TREATMENT. In order for you to have a case, you must receive treatment, and STAY in treatment. Under ERISA (Employee Retirement Income Security Act), you have the right to file a lawsuit to recover unpaid benefits. If you do not have unpaid benefits, there is no ERISA claim. This means that you must go to treatment and stay there, even if you receive an insurance denial.

2. CONTACT AN ATTORNEY. After you receive an insurance denial in writing, contact an attorney for help. Don’t be intimidated by the thought of seeking legal advice! Some attorneys (including Kantor & Kantor) offer free consultations and work on a contingency- fee basis, which means they do not collect a fee from you unless your claim is paid.

3. KNOW THE RULES. Before you can begin advocating for the health benefits to which you are entitled, you must have a copy of your insurance policy. Request a copy of your insurance policy- without it you will not understand the rules. Every policy is different and can have different deadlines.

4. STAY OFF THE PHONE. At Kantor & Kantor, LLP, we understand how challenging and overwhelming the prospect of trying to get answers from your insurance company can be. We advise that you try to stay off the phone as much as possible! All communication should be in writing, in traceable forms such as certified mail, fax or e-mail. If you can't prove it, it never happened! Although it's not always possible, while you are on the phone try to get the name, title, phone number and email address of everyone you talk to. Speaking with different insurance representatives can become confusing and overwhelming. Keep a journal of your conversations so that you can refer back to them later.

5. KNOW THAT AN INSURANCE DENIAL IS NOT THE FINAL WORD. Unfortunately, an insurance denial is often part of the process. Use this as you opportunity to appeal the insurer’s decision and prove your case. For guidance and support in appealing a denial, contact an attorney for expert advice.

Although this explanation seems relatively straightforward and simplistic, dealing with insurance companies and their legal jargon can be complicated, confusing, and overwhelming. Stick to the 5 rules listed above, and contact our office with any questions.

We understand, and we can help.

(800) 446-7529 www.kantorlaw.net

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