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

They may actually be better positioned to do the first appeal for you, or you can work with them.

But you'll want them to explain why this is care that's really important to your health and why you need it, and it shouldn't be denied.

What I heard from the advocates is that, yes, being persistent can pay off.

It doesn't always.

You've got to be realistic, but it can.

There are different levels of appeal, and ultimately it can go to an outside third party party.

And information about how to do that should be given to you in any letters you get from the insurer.

In terms of the rate of success, that's not always disclosed.

It's not always clear, and it does vary.

But there was one study that the Federal Office of Inspector General for the Department of Health and Human Services did that found that 75% of denials were overturned on appeal for Medicare Advantage plans.

So that's a pretty high number, and it just illuminates that, yes, appeals can work.

There are all sorts of different ways things can be rejected.

And that's why an initial phone call is good.

And it's also why you want to work with your doctor or hospital or the health care provider who is involved, because you'll often find that those entities have appealed many times before and kind of know the ropes on how to do it.

But you'll find that things can be rejected because the health insurer says it's not medically necessary.

So that would be one thing, like just don't think this is a treatment you needed.

But they can also reject things because it's not a service that your plan covers.

That's a different kind of rejection.

And that may be more challenging in some ways.

As an example, there are a decent number of health plans that don't cover drugs for weight loss.

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