When a health insurance company is deciding whether to pay for your medical treatment, the company generates a file around your claim. All the records associated with your case should be part of your file. This includes documents explaining the reasons your claim was denied.
You have a right to see this file. Federal regulations require most health insurance plans to give people an opportunity to review documents related to their claim for free. So if your insurer talks to your doctor, if a nurse takes notes, or if two people speak about it on the phone, all of those records should be available to you.
“It’s a treasure trove of information,” said Juliette Forstenzer Espinosa, a health lawyer and senior lecturer of health policy at George Washington University. “But most people have no idea how to get it.” (...)
Taken together, these documents can offer a window into the opaque system of health insurance denials. Details in them have helped us report on some of the country’s largest insurance companies and their attempts to cut costs at the expense of patient well-being.
We have spoken with patients, health care providers, former and current health insurance employees and health policy experts to better understand how people facing denials can request their information. We believe it is important to share with our readers what we are learning about this process. To that end, we have collected advice on requesting your claim file and answers to common questions you may have, including a template you can use to get your request started.
by Maya Miller, Patrick Rucker and David Armstrong, ProPublica | Read more:
Image: Daniel Fishel for ProPublica
