Julie Wernow

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51 appearances 1 recordings 1 series first heard Feb 2025 last heard Feb 2025

Julie Wernow’s voice in public audio — every appearance, attributed to the second.

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WSJ Your Money Briefing · Why Appealing Your Insurance-Claim Denial Could Pay Off · 13 Feb 2025 podcast

If you get another denial, you can do another what they call second appeal, which escalates it to a higher level within the insurance company.

And then if you get another denial, in pretty much every state, there's an

outside review agency is supposed to act as like the watchdog for the insurance company, you can appeal to them.

And in addition to that, you can ask your doctor to talk to a doctor inside the insurance company and try to get that denial overturned.

You also have a right to your entire claim file.

So you can write to the insurance company and demand all the documentation that they've used to make the denial that they have, because often when these denials come through, they're very

light on details it'll just say this is not medically necessary what qualifies something as being not medically necessary what's interesting is that sometimes what's not medically necessary is codified in law and that can be different in different states there's a lot of one-off laws that i found while i was reporting this story for different diseases where they said this disease you have to treat it if you're an insurance company it's medically necessary

Other times it's left up to the insurer to determine what is medically necessary, which can leave people who are trying to fight their insurers in a pretty tough spot.

I encountered people who were literally physically incapacitated.

One of the folks that I talked to as I was reporting out this story was on a ventilator.

And so you're relying on your caregiver to do that on your behalf and you have to make sure you have the right paperwork in order.

And so the idea of then having to sort out an appeal process for an insurer when you're just one person and you know that insurer is much bigger than you are can be enough of a barrier that a lot of people don't even try.

But if you are in a situation in which it is truly an emergency that you get a decision, you can file for an expedited appeal.

I talked to people who were getting responses within hours and people who were able to get responses within 72 hours.

If the health insurer determines that your situation doesn't warrant an expedited appeal, it can take weeks, up to 30 days and

And if, for instance, you were relying on your doctor and it took them 30 days to file the appeal, then we're talking about potentially two months before you find out if they are going to deny it again.

And you have to then escalate it to the next level.

Sometimes it's really a very innocent reason that something was just denied potentially incorrectly.

It might have been your doctor put in the wrong code or said that they were going to get it from an out-of-network pharmacy, but it turned out that you could have gotten it in an in-network pharmacy, right?

There are a lot of things that sometimes are not actually huge barriers for the insurer.

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