Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Don’t fall victim to health insurance denials

Jane Arnoff Logsdon, LSW
Patient
March 14, 2015
Share
Tweet
Share

I consider myself a pretty savvy and resourceful consumer. I know how to solve problems that come up in the day to day situations we all face. I have navigated my way through more than a few complicated and sensitive financial situations. Add to that my ability to be persistent, and you would think that I could figure out a simple denial of an insurance claim with ease, right? In this case, the answer is no.

Here’s the situation: My husband decided to quit smoking after many years of puffing away by using a smoking cessation program. I assumed that our medical insurance would cover the program and did not bother to check on this before he went to his appointments. According to their website and the literature, they support smoking cessation and even offered free nicotine patches to members. Our medical facility had paved the way for supporting smoking cessation efforts on the part of their employees and patients. So, needless to say I was very surprised to receive a bill from the provider as well as an explanation of benefits stating that the claim was denied. I tried to put my frustration aside in order to solve the problem. I appealed the claim online and felt pretty confident that the appeal would be granted. After a few successful clicks, I sat back and waited for the good news.

Instead, I received a five-page, single-spaced document instructing me (I think) about how to further appeal the claim. After undertaking the dizzying task of trying to decipher this document, I contacted the nurse practitioner at the smoking cessation program to ask for her help with the denial. After some research on her end, she told me that she thought that the nature of the billing or perhaps the specific coding caused the denial. In the last conversation, she said that she would do a little more research and get back to me on how to pursue the denial.

As for the insurance company, a helpful but mildly perplexed representative asked me to go back to the provider to find out how the claim was billed. I spent another few minutes reviewing the mega document, hoping it would explain itself. No such luck. After days of waiting, the Nurse Practitioner did not return my call. Eventually, after some more hair pulling and fretting, I decided to give up.

I do feel a little sheepish in telling this story, as if I should have known better or been more prepared. However, I did learn some good lessons from the experience that I can share with others and make sure they don’t make the same mistake. First of all, don’t assume a service is covered by insurance no matter what your plan. Insurance companies have very detailed benefits documents — you need to review all the details. Next, make sure to assess any services and related charges you receive during the visit — they all will appear on the bill. Finally, take advantage of covered preventative care that the insurance company covers. It is important to maintain your health and prevent major issues later on down the line. During my experience, it seemed that all the players in this game were at least a little confused. I came away from this experience feeling humbled, wiser and with a lot to pass along to others to help prevent them from falling victim as I did.

Jane Arnoff Logsdon is a contributor, Costs of Care essay contest.

costs_of_care_logo_small

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American health care delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

Prev

MKSAP: 66-year-old man with a persistent rash for 6 years' duration

March 14, 2015 Kevin 0
…
Next

Medicine is immersed in the customer service mentality

March 14, 2015 Kevin 11
…

Tagged as: Patients

Post navigation

< Previous Post
MKSAP: 66-year-old man with a persistent rash for 6 years' duration
Next Post >
Medicine is immersed in the customer service mentality

ADVERTISEMENT

More in Patient

  • AI’s role in streamlining colorectal cancer screening [PODCAST]

    The Podcast by KevinMD
  • There’s no one to drive your patient home

    Denise Reich
  • Dying is a selfish business

    Nancie Wiseman Attwater
  • A story of a good death

    Carol Ewig
  • We are warriors: doctors and patients

    Michele Luckenbaugh
  • Patient care is not a spectator sport

    Jim Sholler
  • Most Popular

  • Past Week

    • Psychiatrists are physicians: a key distinction

      Farid Sabet-Sharghi, MD | Physician
    • The blind men and the elephant: a parable for modern pain management

      Richard A. Lawhern, PhD | Conditions
    • Is primary care becoming a triage station?

      J. Leonard Lichtenfeld, MD | Physician
    • Preventing physician burnout before it begins in med school [PODCAST]

      The Podcast by KevinMD | Podcast
    • The consequences of adopting AI in medicine

      Jordan Liz, PhD | Tech
    • The risk of ideology in gender medicine

      William Malone, MD | Conditions
  • Past 6 Months

    • Psychiatrists are physicians: a key distinction

      Farid Sabet-Sharghi, MD | Physician
    • Why feeling unlike yourself is a sign of physician emotional overload

      Stephanie Wellington, MD | Physician
    • The U.S. gastroenterologist shortage explained

      Brian Hudes, MD | Physician
    • The Silicon Valley primary care doctor shortage

      George F. Smith, MD | Physician
    • California’s opioid policy hypocrisy

      Kayvan Haddadan, MD | Conditions
    • A lesson in empathy from a young patient

      Dr. Arshad Ashraf | Physician
  • Recent Posts

    • The consequences of adopting AI in medicine

      Jordan Liz, PhD | Tech
    • Pediatrician vs. grandmother: Choosing love over medical advice

      Jessie Mahoney, MD | Physician
    • How I got Dr. Luis Torres Díaz on Wikipedia: a grandson’s journey

      Francisco M. Torres, MD | Physician
    • Direct primary care vs psychotherapy models: Why they aren’t interchangeable

      Arthur Lazarus, MD, MBA | Physician
    • The hidden depth of the rural primary care shortage

      Esther Yu Smith, MD | Physician
    • When hospitals act like platforms, clinicians become content

      Gerald Kuo | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Psychiatrists are physicians: a key distinction

      Farid Sabet-Sharghi, MD | Physician
    • The blind men and the elephant: a parable for modern pain management

      Richard A. Lawhern, PhD | Conditions
    • Is primary care becoming a triage station?

      J. Leonard Lichtenfeld, MD | Physician
    • Preventing physician burnout before it begins in med school [PODCAST]

      The Podcast by KevinMD | Podcast
    • The consequences of adopting AI in medicine

      Jordan Liz, PhD | Tech
    • The risk of ideology in gender medicine

      William Malone, MD | Conditions
  • Past 6 Months

    • Psychiatrists are physicians: a key distinction

      Farid Sabet-Sharghi, MD | Physician
    • Why feeling unlike yourself is a sign of physician emotional overload

      Stephanie Wellington, MD | Physician
    • The U.S. gastroenterologist shortage explained

      Brian Hudes, MD | Physician
    • The Silicon Valley primary care doctor shortage

      George F. Smith, MD | Physician
    • California’s opioid policy hypocrisy

      Kayvan Haddadan, MD | Conditions
    • A lesson in empathy from a young patient

      Dr. Arshad Ashraf | Physician
  • Recent Posts

    • The consequences of adopting AI in medicine

      Jordan Liz, PhD | Tech
    • Pediatrician vs. grandmother: Choosing love over medical advice

      Jessie Mahoney, MD | Physician
    • How I got Dr. Luis Torres Díaz on Wikipedia: a grandson’s journey

      Francisco M. Torres, MD | Physician
    • Direct primary care vs psychotherapy models: Why they aren’t interchangeable

      Arthur Lazarus, MD, MBA | Physician
    • The hidden depth of the rural primary care shortage

      Esther Yu Smith, MD | Physician
    • When hospitals act like platforms, clinicians become content

      Gerald Kuo | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Don’t fall victim to health insurance denials
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...