How to Dispute a Claim With GHI

You can dispute a claim with GHI by filing an official dispute with its office in writing or by telephone.

Medical claim settlements with the health insurer GHI can be disputed. In most cases a dispute arises when the insurance company declines to pay the full amount of the claim submitted, or pays only part of the claim. The insured person then is liable for the remaining balance owed to the provider. To dispute a claim with GHI properly, you will need to follow some simple steps.

Things You'll Need

• GHI account number
• Bill from provider outlining charges not paid

Instructions

1. Call your health care provider or billing office at the hospital or doctor that you visited. Ask them to detail the charges they submitted to GHI, and the reason their office was given that the charges were denied or only partially covered.

2. Ask your health care provider to resubmit the claim to GHI on your behalf.

3. Contact GHI by phone at 866-557-7300 and ask the company to provide a written statement as to why your recent claim was denied or why only a portion of it was covered. Advise the representative that your health care provider will resubmit the claim to be considered again.

4. Write to GHI at P.O. Box 4296, Kingston, NY 12402. In your letter, state why your claim should be reconsidered for payment. You will need to explain, in detail, why your claim is legitimate and why the insurance company should be covering the expenses. For example, if GHI claims that you did not use an in-network provider, you will need to provide evidence that an in-network provider was not available. Also, if GHI claims that you did not receive a pre-authorization for the treatment, you will need to provide evidence that it was a necessary emergency procedure.

5. Continue to follow up with GHI by phone every few days on the status of your claim. The company will provide written confirmation of any status changes to your claim. This process can take months or even years.

Tips & Warnings

• Once you have begun the official process to dispute your claim, you still may receive notifications from your health care provider that payment is due. You are technically still responsible for payment, and the provider can refer your bill to a collection agency if you refuse to pay. Try to work out a payment plan with the provider while you contest your claim with GHI. If GHI ends up covering the costs, provide it with receipts showing that you paid a portion of the balance due. GHI will reimburse you directly.

References

• GHI
• GHI Grievance and Appeals Process