Insurance companies are often reluctant to pay for anxiety-related treatments since the medical evidence necessary to establish anxiety-related health claims are nothing like those for physical claims. While many types of physical illness are easily demonstrated with a simple lab test, anxiety-related disorders are not quite so evident, at least not on paper.
Why Are Anxiety Health Insurance Claims Often Denied?
Insurance companies are in business to make money, which is why they will often deny a legitimate anxiety health-related claim. Insurance companies gamble that a certain percentage of people will not appeal their denial and since a significant percentage of denied claims are never challenged, it pays insurers to deny an initial anxiety-related health claim.
If your insurance carrier has denied claims for anxiety treatments or other related medical expenses normally covered by your policy, you will need to gather together detailed information and records to help you in your appeal for coverage. Make sure you have all your paperwork in order and that you understand your coverage. Also be sure that you carefully follow the insurance plans appeal process, since claims for appeal can only be made for a limited time from the date you received services.
Your doctor can help strengthen your case for treatment coverage by contacting the insurance plan's coverage decision makers. Many plans decide whether or not to cover treatment depending on the necessity of medical intervention for the patient's well-being, also taking into account the health condition of the patient and the appropriateness of the treatment for that condition.
How to Appeal Your Denied Anxiety Health Insurance Claim
The process of appeals will vary from plan to plan, but often the first step is making a phone complaint, which may need to be followed by an appeal in writing. Written appeals are generally the first step in the appeal process. Your written appeal should contain a request for more information about the denial and a request for the insurer to reassess its decision. Your insurer should provide specific reasons for denial and detailed instructions for initiating appeals and a time-frame for filing the appeal. If your insurer does not provide this information to you in writing, you should request it. There may be a time limit after which you are not entitled to make a complaint regarding a given claim, so make your appeal as soon as your claim is denied. The typical time frame is 60 days from the time you receive your initial explanation of your benefits.
If you will need a formal review regarding the denial of your coverage, call the administrator of your health plan to find out the name and address of the correct individual to contact with your appeal letter. Make sure to send the letter by certified mail to give you a receipt and record of the date that the letter was sent and received. This will give you proof that you made the claim within the limits provided and can also hasten the company's resolution of your request. When you make your formal review you are entitled to see every piece of documentation used in determining your benefits. This can be very important since a claim can be denied for something as minor as a procedural coding error. In this case, all that would be required is to resubmit the claim with the proper coding in order to obtain benefits.
Filing an External Appeal
External appeals are filed when appeals to the insurance company have run out and you still have not received relief from the insurer. When you file an external appeal, you are appealing to your state insurance department or other state organization that covers insurance. In a good number of states, laws have been enacted for external appeals that entitle you to review by an independent board of qualified experts. If this board decides the appeal in your favor, the insurance company will have to play the claim.
Each state has different ways of helping consumers with health insurance appeals so be sure to check with your state’s department of insurance to see what external help is available to help you in your appeal. In some states, the physician may legally have a role in appealing a claim for his or her patient. In certain states, plans which punish doctors for advocating for insurance relief for their patients are prohibited. Some states even sponsor free patient-assistant groups to help consumers with their appeals.
