Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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Health insurance company won't pay so man is worriedIf the health insurance company won’t pay, don’t worry. You still have other options to pursue. Every insurance company typically has a complaints section to deal with appeals on decisions.

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If that doesn’t work and you are convinced that you deserve the payment, you can always go to your state department of insurance and lodge a complaint.

If worse comes to worse and you can’t get your claims paid after appeals and complaints at multiple levels, you can always claim the expense on your income taxes at the end of the year.

Appealing to the Insurance Company

If your company refuses to pay a claim you have submitted, take the time to investigate before getting upset. Often claims are refused because paperwork was filled out incorrectly, information is missing or something was incorrect in the claim filing process. Other times, those doing approvals, including computers, make mistakes.

Therefore upon finding out that your claim has been refused, contact the company and ask for an explanation. Make sure you understand what they are telling you and get a written refusal of payment. Ask what you can do to rectify the situation.

If you are unable to fix the problem through a customer service representative, make sure you ask to speak with his or her supervisor. Often people who have supervisory roles also possess more power in fixing problems.

If this does not work, inquire about the formal appeals process. In the meantime, make sure you have documented all communications with your insurer and your healthcare provider. Get copies of all documentations, including letters, bills and medical records. These will be necessary to help prove your point.

You should also ask your doctor to help at this point. If you have incurred expenses while dealing with the problem, document them also. Fill out the appeals form completely, providing copies, but not originals, of all relevant documents and wait to hear the results.

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Making a Complaint to the State Department of Insurance

If, after appeals at multiple levels of the insurance company, you still have not gotten a satisfactory response to your problem, you will need to take it elsewhere. You can file a complaint with the state department of insurance.

This government division can often act as a mediator and attempt to settle the issue and have it resolved in a just manner. This is a free service. If this fails or the service is unavailable in your state, hire a professional arbitrator or lawyer to help work it out.

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Take Out a New Policy

Experiencing a situation whereby your health insurance company refuses to pay a claim that you feel they should cover can leave you feeling bitter and disappointed in a plan that you relied on. Your trust in your insurance company has been broken. If this is the case for you, the best option for dealing with it is to accept it as a life lesson, claim the expenses on your income tax return for the year if you get no resolution in the situation and get a new health insurance company.

When you are ready to take out a new health insurance policy, you will need to learn as much as you can about the different types of plans out there, as well as the impact things like deductibles , limits, co-pays and out-of-pocket expenses play on the policy you take out. This will prepare you to be able to make a choice in an area that can be very confusing.

Before selecting a new health insurance policy, shop around for a variety of quotes from companies serving your area. You can do so with ease and confidence by using the free online insurance quotes tool which collects your relevant information through a series of questions and then submits it to companies that meet your needs. In no time, you will have the quotes you need to compare and contrast prior to making your decision.

Once you have the quotes and are looking at them in detail trying to decide which is best, you will want to investigate the companies themselves to make sure you won’t have a repeat of the problems you had with the company you are leaving. You can find out about the financial strength of a company by getting their grade from an independent insurance rating company like Moody’s or A.M. Best. To find out about how they treat their customers, get consumer reviews from an online search or contact your state department of insurance for details on consumer complaints.

Get started today looking for a new health insurance policy by letting an online health insurance tool do the work for you.