Oliver needed hand occupational therapy. Unfortunately, it wasn’t covered by my primary insurance. Lucky for me, my work provides a secondary insurance that picks up some of the benefits missed by the primary.
Secondary insurances can be tricky, but I know the rules.
As far as my plan is concerned, if it isn’t a covered benefit under the primary, no letter of denial is required. Great, I thought. Hand OT is not a covered benefit, so no problem. So I submitted my $1875 for Oliver’s hand OT, filling out the form exactly right (because they will deny you in a heart beat if you make a typo!).
And guess what I got? I got a nice denial letter.
Two pages of bullshit mumbo jumbo designed to do only one thing – confuse. Somewhere in the back page, in a layout designed to be glossed over, was some info about what to do if I wanted to appeal.
Pissed off as all hell, I got on the phone. I spoke to a nice man. Troy (always ask for their names and write down date and time you talked and everything that was said).
There was hemming and hawing and silence. No, he could not find a reason why the claim was denied. It was an eligible benefit and the form was filled out just right.
“I’ll take care of it,” he said.
So I called back today, because the check, supposedly mailed 5 days ago, has yet to arrive. I thought I’d give it one more whirl.
“No”, the lady I spoke with could find no reason for the denial either.
That’s because automatic denials are common place. Hell, with most insurances they are the norm.
Why? Because many people don’t understand what they are reading. Others think they have no chance, so what’s the point? And to some, an appeal just sounds too daunting. And insurances companies, like my Cigna buddies, know this only too well. Even if 3% of people don’t appeal it’s worth it, because that is probably millions of dollars in prevented claims every year. I’ll bet far more than 3% never appeal their denial.
So always, always, always appeal your claim. You never know. It costs you nothing.
And like me, if you got an automatic denial (a denial that no one can seem to explain)? Send a note to your state’s insurance commissioner. If they get enough e-mails, they might look into it.
And to the politicians? Your 1rst step in reforming heal care should be fixing the obvious, like imposing massive penalties for automatic denials, say $100,000 per occurrence. If I were in charge, that’s what I’d do.