Linda Young - News Writer All Headline News July 19, 2007 1:15 p.m. EST
Atlanta, Ga - Although the recent emphasis has been on how hard it is for uninsured Americans to gain access to health care even insured patients with legitimate claims have a beef with the health insurance industry in the United States. About one-fourth of all people have had a valid claim for payment denied by their insurance company. However, one Atlanta area family that fought one claim denial after another finally won and has tips on how other people can win the battle with their insurance company to force it to pay valid claims. The figures on claim denials come from a recent survey by PNC Financial Services Group that found nearly one out of four consumers been denied payment of a valid claim by their health insurance company.
In Atlanta, Todd Robinson's 7-year-old son Bailey had a rare genetic disorder that affects the brain. Called adrenoleukodystrophy, the condition was depicted in the movie "Lorenzo's Oil."
His insurance company denied $200,000 in valid claims for his son, who died in 2005, Robinson said.
"I don't make a lot of money" and there was "no way I could pay $200,000 out of my pocket," he said, according to CNN reports. It turns out they didn't have to.
Using some specific techniques, Robinson managed to overturn all their insurance company's claim denials. He says that to fight a claim denial people should do things such as get the help of their health care provider and office staff to re-file the claim, be persistent, make sure the words used indicate a medical necessity and if necessary hire an attorney. In the meantime, all that red tape on claims is costly.
Researchers at Harvard Medical School and Public Citizen found that bureaucratic overhead is responsible for 31 percent of U.S. healthcare costs, compared to only 16.7 percent in Canada, Britain's Socialist Party news reports. In addition, healthcare spending in America is double that of any other advanced industrialized country, but 47 million Americans remain uninsured.
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