Some say insurance is like a bet, you place your money and you don’t know if it will pay you back with greater amount or it will give you a big disappointment. Well, it’s not 100% wrong, many people have experienced this situation, having an insurance, feel safe, and when a disaster happen the insurance company only give an apologize because from some reason they cannot pay your claim.
The sad thing is, mostly in the situation like this you cannot blame the insurance company because they usually play by the rule and it is all written in the policy. The most reason why people don’t get paid for their claim is because they simply don’t understand the policy in and out. Before you buy any kind of insurance you should study the policy carefully, and review it regularly in case there is anything you missed. Don’t hesitate to call your agent and ask them to give you clear explanation of the policy, or to ask them questions in case there is something in the policy that you don’t understand. Know all the exclusions and limitations, and of course read carefully the section that explains how to make a claim.
When dealing with the type of insurance that pays your bill for some kind of service like mechanic or doctor, be sure that you let the provider knows what is covered and what is not. So you will be sure that they will not do any uncover able procedure.
Check for provisions carefully, there are some certain procedures in some policies that require you to get authorization before start going with the process, so if you want to get paid just follow the guidelines given.
Sometimes, a claim denial could happen simply because of an administrative error. So every time you get a claim denial, look over to your policy and search for the section that related to your case and make sure that it is really a legit denial. Once you find a mistake and you are sure that you are suppose to get paid for your claim, call the costumer service immediately and explain your situation, if it is just a simple administrative error usually your problem will be solved after the first call.
If you are sure that the claim denial is legitimate and there is nothing else you can do to fix it, then request a formal review of your claim from the customer service representative. Then send a certified letter stating your case in writing and request a return receipt. This should be done quickly because many insurers have time limits on appeals.
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