What should I do if my insurance company is denying payment on a procedure that was pre-authorized?

Answer by  patti (29325)

Contact the Office of Insurance in your state. The Office of Insurance makes sure that providers abide the regulations and standards, whether for auto, home, health, etc. No insurance company wants to tangle with the State Office of Insurance.

Answer by  patti (29325)

If everything is in order (the claim was filed on time, you have the pre-authorization info, etc.), make a complaint with the Department of Insurance in your state. This office monitors insurance companies to protect the consumer. You will find contact information online or in the blue pages (government listings) of the phone book.

Answer by  Rose (6804)

There are many things you can do to fight your insurance company. If you have prof that the procedure was pre authorized then you need to make copies and supply them with the pre-authorization as well as sending copies to your states department of Insurance Investigation. Other options would be to have your doctor fight for you as well.

Answer by  olive8 (911)

You will want to start with their customer service department. If that fails then you need to look at your insurance contract as you may be bound to arbitrate the matter before proceeding to other legal alternatives.

Answer by  gshort6228aolcom (30)

Contact your insurance company and speak to a representative to find out their explanation for the denial. Then contact the Doctor or Hospital and tell them to resubmit the claim.

Answer by  xsut (943)

Insurance is regulated by the various states so you can contact the state agency that is over health insurance in your state.

Answer by  Jessie124 (1885)

Call the company and if the representative can't help you, ask to talk to someone higher up. Sometimes it's a simple keystroke that can bounce back a claim.

Answer by  diva25 (4016)

Try and find evidence that has the claim on it. Go down there and show it to them and/or call them. If they deny further take legal action.