First and foremost, this article is for informational purposes only and is not legal advice.  The only way to obtain legal advice is to speak with an attorney licensed in the state where you live.  That said, there is nothing wrong with trying to educate yourself, which is the purpose of this post.  But please remember:  insurance can be complicated and it is always a good idea to consult with an attorney before dealing with an insurance company.

It just came in the mail - another form letter from your insurance carrier - this time stating that they are denying your insurance claim.  You owe thousands in doctor and hospital bills, most of which are overdue, and now you don’t have money to pay these bills and your rent.  What are you supposed to do?

What to do When Your Claim is Denied?

1.  Don’t give up.  It’s sad, but many insurance companies deny a certain percentage of claims, figuring that most insureds will just give up.  They have an incentive to make it hard for you to get paid.  For every insured who gives up, the insurer gets to keep the money it was supposed to pay on the claim.  And every dollar the insurer doesn’t have to pay in claims is another dollar toward the all-important bottom line.  So don’t do it; don’t give up.  Dealing with insurance companies is frustrating and takes time, but a little persistence can make the difference between a denial and payment. 

2.  Be polite and professional.  It goes without saying, but  remember that, even though you are dealing with an insurance company, real people are making decisions about your claim.  So be polite, courteous, and professional . . . it will go a long way toward helping resolve the matter.

3.  Get a copy of your policy.  You can’t make intelligent decisions or understand your rights if you don’t know what your policy says.  Remember, an insurance policy is simply a contract between you and the insurance company.  There generally will be a policy and a summary description of the plan.  Get copies from your carrier and your employer.  And read them.   

4.  Do everything in writing.  This might be the most important rule.  In the world of insurance, a telephone call means almost nothing.  If a telephone conversation, or a promise, or advice about your claim are not documented in writing, the insurer can always deny that it happened.  So after you get off the telephone with your carrier, and they just told you they’d pay your claim after you send in some record or form, do this:  make a note of your call — write down exactly what was said, who you spoke with, and the date and time of the call.  Then, when you send in the form, include a cover letter recounting the the details of the call – the date, the time, who you spoke with, what they said and promised.  That way, the carrier cannot deny that it happened.     

5.  Make the carrier tell you why.  In most states, the insurer is required to give you certain information when they deny your claim.  Typically, the insurer should provide: Read more »

This video is great.

As we all know, the insurance business is about spreading risk across a pool of people who have known “statistically significant” risk factors. Age, gender, residence, etc are all taken into account because insurance companies have experts, called “acutaries,” telling them that these factors make a difference across thousands of policyholders.

And maybe they’re right. But this guy does a great job pointing out how stupid these factors are when applied on an individual basis.

Take a look below:
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