SPRINGFIELD, Ill. (WAND) — Many people have either received a health insurance claim denial or know someone impacted by the setback. An Illinois advocacy group is spreading awareness about how consumers can appeal the claims.
Insurance companies process millions of claims successfully every day. However, the Illinois Life and Health Insurance Council knows there are cases where patients can be denied care.
"We want consumers to get the care that has been recommended for them," said ILHIC President Laura Minzer. "If they can't get that, if it's not covered under their policy, what other alternatives exist for them?"
Minzer said people need to read and understand their denial letter. Patients can call their insurance company with any questions and ask to go through an internal appeals process. Most issues can be addressed by working with your insurance provider.
"If that doesn't happen, then there are other steps that can be taken through the Department of Insurance through what's known as an external review process where an independent party that isn't your insurance company and isn't your provider is reviewing all the information," Minzer said. "They may, in fact, turn it over so you do get access to care."
People can also ask for an expedited appeal if they are in urgent need of care. Minzer said an expedited appeal could be completed within 24 hours. Although, traditional appeals of denied claims could take anywhere between 48 to 72 hours.
"Your premium, what you pay every month, should be working for you," said Minzer. "So, insurance should be working for you."
Of course, there are some cases where insurance companies don't respond in a timely manner. Consumers can file complaints with the Illinois Department of Insurance and Attorney General's office.
Minzer stressed that consumers have rights and there is a process they can utilize to get lifesaving care.
"It's not unreasonable to think that there are many people out there who have never had this experience," Minzer said. "It can be scary and stressful. Nobody wants to be told no."
The Illinois Life and Health Insurance Council will be sharing a step-by-step guide for the appeals process on their social media accounts and website.
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