Headline : What to Do When Health Insurance Denies Care You Really Need

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If there’s anything worse than being sick, it’s being sick while dealing with insurance issues. But unfortunately, that situation is all too common. Recent research from the Commonwealth Fund, a private foundation that researches health care issues, finds that 17% of U.S. adults have in the past year had their insurance company deny doctor-recommended care, with denials happening about as frequently for people on both commercial and government insurance plans.

Denials can occur either before you’ve gotten a test, procedure, or treatment—when a provider submits a request for prior authorization, for example—or after you’ve already received care. The insurer may argue the service isn’t one it covers or is medically unnecessary for you, or it may deny care on logistical grounds, like a claim having incorrect information or coming from an out-of-network provider.

Receiving a denial letter can be discouraging, but you can take certain steps to fight back. Here’s what to do.

It’s easy to let your eyes glaze over when faced with a letter full of jargon, but it’s important to read it carefully, says Jeremy Gurewitz, CEO of Solace, a company that connects consumers with advocates who help them navigate the health care system. Your letter should spell out exactly why you were denied coverage—and that reason is important to know, Gurewitz says, because it determines your next steps. Your issue may have a fairly straightforward fix, like providing additional paperwork or re-submitting a claim with different information. Or, it may require putting together an appeal to argue that your doctor’s treatment plan is, in fact, medically necessary. Gurewitz recommends starting with a call to your insurer’s customer service line, as some issues can be worked out on the phone.

Read more from the original article on here at time.com.

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