Health insurance is delaying my claim. I got a letter requesting a "Claims and Eligibility Review". What should I do?
In a letter, they’d like to review my medical history from a few years ago, and would like me to authorize access. They place this caveat: “under no obligation to sign this form and that we may not condition payment health plan enrollment or benefits eligibility on my decision to sign this authorization, unless this authorization is being sought for determinations of health plan enrollment, eligibility, underwriting, or risk rating.”
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5 Answers
I would call and speak with someone. Contact info should be on the letter.
Calling is a good idea.
It sounds like they are looking for more information about your claim so that they can try to approve it. They will not drop your insurance or refuse to pay for other claims if you don’t authorize access to your medical history, but they will also not approve your current claim.
Please know that some claim codes are programmed to be denied and you must resubmit with additional information for them to be paid. It’s a crappy system… but hopefully with more information your claim will go through.
They should be friendly, helpful and quick on the phone. If not, ask for the supervisor.
If ^ that doesn’t work, get a lawyer.
It is a crappy system. They can no longer deny you coverage for pre-existing conditions, but they can tie up your claim until you’re miserable and give up by using “non-disclosure” as an excuse.
You also don’t have to give police permission to search your car on a traffic stop but denying it doesn’t necessarily make your life any easier.
Do call a supervisor and have a crossword puzzle handy to work on while you’re on hold and transferred… and transferred.
Ask specifically what they are looking for and why they believe it’s relevant.
Is your latest hospital stay related to your past medical history? Example: are you on workers comp, or do you have an existing illness that you should disclose? If not, it is none of their business and I would not disclose any other information to them.
I would call and ask them why they are requesting this information though.
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