How to Dispute Outstanding Insurance Claims
Every responsible adult needs to carry sufficient insurance coverage, and the purpose of that insurance is to protect you and your family in the event of an unexpected loss. The problem is that insurance companies can often be reluctant to pay the money the owe on claims, so it is up to every consumer to learn how to dispute outstanding insurance claims and come to a favorable resolution.
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Instructions
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Pull out a copy of your insurance policy and read it thoroughly. Whether you are dealing with a health insurance claim, auto insurance claim, life insurance claim or some other type of claim, it is vital to know your coverage so that you know where you stand. If there is anything in the policy that you do not understand, it may be worthwhile to ask an attorney for advice. This is particularly true if the claim in dispute is for a large amount of money.
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Contact the insurance company by telephone and ask to speak to a claims resolution specialist. When contacting any company by phone, it is best to skip the front line representatives and go right to the individual who has the power to resolve your problem.
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Provide the representative with as much information as possible, including the dates of service, the justification for any procedures and the total cost of the services rendered. Explain your situation calmly and try to come to a resolution.
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Ask for a formal appeal form if you are unable to come to a suitable resolution over the phone. Even if you do come to a suitable resolution with the claims resolution specialist, it is important to follow up with a letter detailing your conversation and the terms of the claim payment. When you receive the appeal form, be sure to fill it out completely and mail it back promptly. Always make copies of all paperwork for yourself before you mail anything to the insurance company.
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Follow up after a week has passed to check on the status of your appeal. Continue following up weekly until the claim is paid. If the appeal is denied or the claim is still pending after a month, contact your state's insurance commission for help. Each state has an insurance commission, and part of its mission is to help consumers handle disputes with insurance companies.
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