While I thought that it was time for me to stop writing repetitive articles, I am finding out that I just can’t do it.
Four people contacted me this week AFTER their claims were denied. Over the years I have repeatedly said on Lindanee’s Blog that I cannot help you if you don’t contact me before your claim is denied. The only option you have once that happens is to contact an attorney to do an appeal. And, the word out there is that insurers are NOT overturning denials, at least not the majority of them.
The majority of people contacting me with denied claims are those with “questionable” diagnoses such as Chronic Fatigue Syndrome, Migraines, Depression and a few others. These are diagnoses that are not impossible to support, but those that require knowing how to do it. It really does bother me that insureds, in an effort to save money, not only wait until the last minute, but then do things that are the absolutely wrong things to do in order to provide “proof of claim” and overturn denials.
I’m not pinpointing any particular claim here because several people who’ve contacted me have done the same things and are making the same mistakes. Please listen to me carefully here and pay attention to what I am trying to tell you.
Those with ERISA claim denials receive letters “informing of your ERISA appeal rights.” Therefore, the first thing most claimants do is write a letter of appeal and send it to the insurance company.
WRONG, WRONG, WRONG. If you do that, the insurer will immediately send your file back for another medical review REVIEWING THE SAME OLD INFORMATION, and will send you a letter saying there is nothing to change their original denial decision. The insurer will also tell you that “you’ve exhausted” your appeal rights. YOU’VE GOT ONE SHOT HERE, and you just blew it.
Actually, insurers hope that you do this. It saves them time from reviewing new information, and they know not everyone will sue to recover benefits. In the past, I have NOT recommended anyone do an appeal on their own, but again, to save money, people are trying to process their own appeal, and based on my observation only 3-5 percent are overturned. Let me say this again, the best appeal is to not let a denial happen in the first place. And, you can’t do that if you wait until the last minute, or your claim has already been denied.
Usually, I would just tell you how to properly process an appeal, but not this time – I’m asking that you contact me because there’s a great deal more to it. I also know that many readers use my articles to manage their claims and I’m not supporting that anymore, really.
Insurance companies are too bad, too tricky, and are not abiding by any kind of reasonable policy provision or acceptable practices. They have adopted their own strategies to DO WHATEVER IT TAKES to deny claims to make a profit. As a result of that, I am of the opinion that it is better to have expert advice that can make the difference between a denial and benefit payment success. (And, not at the last minute.)
If your disability diagnosis is one of the more difficult to support: CFS, FMS, Migraine, HIV, Epstein-Barr, and other “Syndromes”, please call me and let’s talk. Once your claim is in appeal status the process changes and you need to know what that is. And, please stop what you think is the right thing. It isn’t.
