Anna Wilde Mathews

speaker

275 appearances 5 recordings 1 series first heard Aug 2017 last heard Sep 2023

Anna Wilde Mathews’s voice in public audio — every appearance, attributed to the second.

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WSJ Your Money Briefing · How to Appeal When Your Health Insurer Rejects a Claim · 28 Jun 2023 podcast

You should get the name of the person you're talking to.

But you probably want to file a formal appeal, and you'll typically want to do that in written form.

Well, people have a lot of gripes about their health insurance plans.

There was a recent survey from a nonprofit called KFF, and they found some of the biggest complaints were that insurance paid less than consumers expected for a bill, the insurance didn't cover care or a drug that the patient got, or the insurance denied or delayed pre-approval for a treatment that the patient wanted.

The survey found that 58% of insured adults had run into problems using their health insurance just in the past year.

The survey found that people with more health conditions had more gripes about their insurance.

Also, about 4 in 10 people who said that their mental health was fair or poor said they hadn't been able to get a medication or a service that they needed.

A lot of people don't realize they actually have an appeal process.

They don't realize that there's something they can do when the insurer declines to pay for something.

But there definitely is.

Insurers all have an appeals process.

And in addition to the internal appeals process, there's also the opportunity ultimately to appeal to a third party.

So what consumer advocates told me is that people should do that.

They should not just give up.

They should definitely fight and they might win.

Yeah, absolutely.

What the consumer advocates told me is that a phone call is a good first step, but definitely that's just the first step.

When you call, you should take notes.

You should get the name of the person you're talking to, but that you probably want to file a formal appeal, and you'll typically want to do that in written form.

You'll also typically want to work really closely with your doctor or your hospital, whoever provided the care or maybe prescribed the drug.

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