Illinois Health Insurance
Having an Illinois health insurance plan is an ideal way to protect yourself and your family in case of sudden illness or accident. If you become sick or injured a stay in the hospital can be a pretty stressful or traumatic experience. The last thing you want to worry about at this point in time is if your insurance company will cover your costs. However, some customers find out after the fact that their insurers may reject part or all of their claim.
If you run into a situation where the insurer is denying your claim the Illinois Department of Insurance recommends a few steps to follow. It’s important that you read and fully understand your health insurance policy. A health plan is considered to be a legal contract between the insurance provider and policyholder. If you’re covered by a group insurance plan then the group itself has entered into a legal agreement with the insurer and each individual is a certificate holder.
It’s essential that you know what your responsibilities and rights are regarding your specific insurance policy. The policy will list exactly what medical procedures, tests and treatment it covers and what isn’t covered. If you don’t understand any part of the health plan you should always ask for clarification before singing your name on the dotted line. If there are still areas you don’t understand it’s a good idea to get in touch with the Office of Consumer Health Insurance.
If your claim has been denied while you’re receiving treatment be sure to contact your Illinois health insurance provider as soon as possible. When speaking to a representative it’s a good idea to keep records of who you’ve spoken to, the dates and times, and make notes of the conversations. Try to stay calm and positive as it will usually make the process easier.
It’s possible that your claim has been denied due to a simple error. For instance, a clerical error may have been made by the hospital’s or doctor’s billing staff when they were filing your health claim with the insurance company. Make sure you ask for the specific details on why your claim has been rejected and if it’s possible that an error has been made. If the insurer still denies the claim there’s no harm in being persistent and making a few calls to them.
If you feel the claim should be paid you can reach out to the Office of Consumer Health Insurance for assistance. However, before you do this you should write a letter to the insurance company appealing the denial. This letter should contain specific reasons and details why you believe they should honor the claim. It’s always a good idea to ask your health care providers for all medical records that could be used as evidence. If you’re still not satisfied you can file a complaint with the state’s Department of Insurance.
The best way to avoid these types of situations is to make sure you understand all aspects of your health care policy. One of the best ways to do this is to contact a licensed health insurance agency and have an indepenedent agent or broker eaplain everything to you in detail.