30 Second Insurance Tips©

Tip #275 – Your Right to Appeal

We fight for our clients. Sometimes, even when the results are predictable.
Jane’s recovery from hip surgery was a little slower than expected. Her policy allows for 20 physical therapy visits. Her doctor recommended more.
Bob Adams (from The Rauser Agency) is Jane’s agent. He’s a seasoned pro and passionate advocate for his clients.  Years ago, he even served on an insurer’s appeals committee. Bob helped Jane prepare her appeal letter and even attended the hearing. In this case, the insurer stuck to the letter of the policy.
Two lessons.
You have the right to appeal when claims are denied. The odds may be against you but if you don’t try, you have no chance at all.
For some elective surgeries – like maybe a hip repair – you might schedule the procedure later in the year. Your physical therapy limit is restored January 1. In this case, Jane might have been allowed 40 PT visits had her surgery date been October instead of March.
So lesson two is, when possible, try and outsmart your insurer.
P.S. Speaker Ryan’s visit with Milwaukee business executives this week garnered much press coverage. I was there. What is the House Republican vision for the future of health care? Click here for their complete proposal.