Keep it simple today and learn as you go through insurance denials: Insurance companies make money when they do NOT pay claims and therefore will seek every opportunity to deny a claim. As a practical matter, the frustration of dealing with insurance companies is in our approach. We refer to them as "my" insurance company, but like referring to a cheating significant other as "my" boyfriend or girlfriend, the insurance company is often an unfaithful and uncooperative partner.
COBRA: The continuation of benefits after an event such as being fired, laid off, or aging out of health insurance coverage. Okay, you've opted into all or part of your coverage through COBRA, meaning you will be covered for a bit longer but you'll be paying more for the coverage.
In the period of time after your change of status leaves you uninsured, but within the time of your ELECTION period for COBRA, you decide to take the COBRA, but your election for some reason isn't coming up and you're being told: "THERE IS NO COVERAGE IN EFFECT FOR THIS PATIENT."
Compose your letter of appeal IMMEDIATELY.
Show the denial of benefits. Show the receipt of payment for such benefits. Include your check number. Send it certified mail/return receipt.
Even if you decide to call, understand that the ONLY thing insurance companies listen to is information in writing. While claims people try to "verbally" avoid doing work of any kind and while insurance companies seek to avoid putting any of the information representatives put in writing to protect their interests, PUT IT IN WRITING.
It's a funny thing, as an aside. In talking with younger people about PHR's, they focused on the "convenience" of having everything online and they were very taken in by the argument in FAVOR OF PHR's that stated you have to have trust. While I admire the youthful hope of such a position, I must reiterate here in this context that "trusting" health insurance companies and their representatives is not wise.
For today, instead of looking at an insurance denial as an aggravating, infuriating, blood pressure raising experience, take a step back and look at the opportunity to learn more about health insurance companies. Remember, they have nothing to lose by saying no and lots to gain (retention of their money forever or for awhile).
