Usually, when navigating the confusing world of health insurance, after every procedure, check-up, etc., you get a lovely little statement from your insurance company. I liked these—mostly because they said “Amount You Owe: $0.” Until last year, when a tiny billing discrepancy with my dentist crumbled into a massive back-office mess. My dentist was really good, and I truly used to like her, but in 2012—almost 3 years after I started seeing her—I got a big bill. As in a several thousand dollar bill. There had to be a mix up! I just assumed they must have billed me for the wrong procedure and all would be straightened out soon enough.
So, I called in. Turns out, the dental office had only received checks for one or two of my seven appointments. Then, I called my insurance company, who told me that the practice had to call them to figure it out. I called the dentist back, and her office told me to hang tight. Three months later, we had the same conversation. And again at the six month mark.
Finally, when we rolled into 2013, I got another bill, and I was fed up. No one from my insurance company or my dentist’s office was listening to me.
And then I discovered how to dispute a claim. And now, I can tell you.
To clarify, this dispute didn’t involve lawyers—if you want to read about that, you can hit up Google. I contested this myself.
First, find out how to file a grievance with your health insurance provider. A grievance is a basically a formal complaint. You can actually call in a grievance, but I chose to file one online because it was quick and I had a written record afterwards.
Grievance forms ask standard questions such as when the incident occurred, who the persons involved were, and what exactly happened. Awesomely, grievance forms also ask you if you tried to handle the issue on your own, what the outcome of your discussion with the providers was, and (perhaps most importantly) what you want the outcome to be.
My dispute ended there. Problem solved: I ended up only owing a mere $9.
But, let’s say your insurance company doesn’t do a great job at responding in a timely manner. You have rights. These are usually spelled out by your insurance company at the bottom of the grievance form. In my case, the insurance company had 30 days to give me a written decision. If I was in that process longer than 30 days, I could file a grievance with my state. This is often done through a branch of the health department, usually called the Department of Managed Health Care or something similar.
No insurance company wants to get the state involved, so hopefully you won’t ever get this far. If things still haven’t cleared up, you have other options before even hiring a lawyer, such as contacting your State Insurance Commissioner. This government line of defense can help you in more areas than just insurance issues. When a friend of mine was going back and forth with AT&T for months on replacing a faulty landline, she called the Public Utilities Commission and someone high ranking from AT&T called her back within hours.
And then, when it’s all over, be sure to tell your state’s Better Business Bureau. Other consumers can use your experience to make informed decisions about their insurance companies. At this point, you have had a rough experience and you should let other potential customers know.
Pro Tip: When filing a customer service complaint in any area—from health insurance to fast food service—the words Better Business Bureau can often help turn things your way.
In some serious cases, you will need a lawyer’s help; but, know that if you look around there are already many avenues carved out for you to get your problems solved.
Photo by Meaghan Morrison