Anna Deutscher, a mother from Minnesota, found herself in a difficult situation when her son, Beckham, was diagnosed with congenital CMV, a virus that can cause hearing loss. Despite the fact that Beckham’s routine hearing tests were preventive care, their insurance denied coverage, leaving the family with out-of-pocket expenses totaling $350 per test. This financial burden, combined with other medical costs, led the family to max out two credit cards in an effort to cover the bills.
Deutscher felt overwhelmed by her son’s medical needs and the constant battle with the insurance company. She was determined to understand why the hearing tests were not covered and what steps she could take to appeal the denial. Here are some key tips for anyone facing a similar situation:
- Check Your Policy: Review your plan documents to confirm coverage and any exclusions or limitations. Even if a benefit is excluded, there may still be options for appeal.
- Is the Service Preventive?: Many preventive services are required to be covered under the Affordable Care Act. Check if the service in question falls under preventive care guidelines and should be covered by insurance.
- Peel Apart the Denial: Understand the reason for the denial by reviewing the denial letter or explanation of benefits. Follow up with the insurance company for specific details and use this information to build a strong appeal.
- File the Appeal: Submit an appeal within the specified timeframe, providing supporting documentation and medical records. If the appeal is denied, try again and consider requesting an external medical review.
- Ask Human Resources for Help: If you have employer-sponsored insurance, consider reaching out to HR for assistance. They may have contacts with the insurance company and could help advocate for coverage.
Deutscher’s decision to involve her HR department proved to be a turning point. Her employer decided to cover the cost of Beckham’s hearing tests for the current plan year, ultimately adding it as a standard benefit for all employees. This outcome lifted a burden off Deutscher’s shoulders and highlighted the importance of advocating for coverage when faced with insurance denials.
Navigating the complexities of the health care system can be daunting, but with perseverance and the right strategies, individuals like Anna Deutscher can overcome challenges and secure the care they need for themselves and their loved ones. If you find yourself in a similar situation, don’t hesitate to explore these tips and resources to fight for the coverage you deserve.
