Many health insurance delays are not actually the result of unethical administration by your insurer, so if you find your treatment is not promptly receiving coverage from your insurer, it is a good idea to make a few phone calls first before assuming that your Texas insurance company is intentionally causing trouble for you. Healthcare.com explains who you should contact in the event you experience delays in your health coverage.
First, if you have direct questions about the amount your hospital or doctor has posted for your treatment, it is a good move to call your doctor or contact your hospital to ask about it. It is likely you will first talk to a person who controls the billing in your doctor’s office. If you feel it is necessary, you will probably want to speak to your doctor as well.
If your insurance company is delaying your coverage, give your insurer a call to ask about the current status of your claim. The first call is likely to be a long one since the customer service representative will have to ask for your personal information and verify your identity before addressing your problem. It will help to be patient at this stage, as insurers need to go through these initial steps before they can deal with you.
However, you should also press on. Remember that your insurer is supposed to be in service to you. If the customer service representative is not providing you with the proper assistance or is not being cooperative, you can ask to talk to the person supervising whoever you are speaking with. Try to go up the chain of command to find someone that will help you.
Also keep in mind that you can perform these same steps if your claim is outright denied. Upon receiving notification of a denial, you may contact your insurer to find out the reason. In some cases, the insurer could claim incorrect or incomplete information on your claim form as the culprit. You might need to ask your doctor to send a clarification to your insurance company. Your doctor may also need to send prior authorization to get your treatment covered, or a letter that spells out why your treatment is medically required.
Finally, if you feel your insurer is not acting in good faith, consider contacting an attorney for help. When all else fails, you should get advice on whether your insurer is delaying or denying you coverage without cause and what action you should take in response.
Keep in mind that since health insurance delays can result from various causes, this article is intended to only inform readers and does not convey legal advice.