Denials of Health Insurance Coverage (5/16/2007)
I have type II diabetes. Recently my doctor and I discussed changing medications to deal with my blood sugar problem. However, my health insurer will not pay for the increased cost. What can I do?
Insurance companies often look for ways to deny coverage to individuals like you who suffer from a chronic illness. Most health plans have institutional rules in place to attempt to lower chronic illness costs. However, you have the right to appeal your health plan decision. Sometimes health plan decisions are made on the basis of the institutional rules without regard to your specific circumstances. Your insurance company must provide you with reason for the denial of coverage. Then, ask your doctor to respond, and confirm the “medical necessity” for the change in medication. If they still deny you coverage, you can appeal in writing according to your policy.
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