What Can You Do when Your Health Care Coverage or a Claim is Denied?

I consider myself very lucky to have good health care coverage. This was not always the case for me. When I was a graduate student in North Dakota, I had reached a point where I was fed up with the lousy coverage provided by the University. I was always having to pay quite a bit of money out of my own pocket for reasons such as "amount exceeds usual and customary charges for this service." Their idea of "usual and customary charges" seemed to differ quite a bit from that of my doctors. Furthermore, there were quite a few things that simply weren't covered by my plan with the school.

A friend of mine had told me that she got a student plan with another company. I decided to do the same. I went to this company and completed all their paperwork. But when all was said and done, I got turned down for one reason and one reason only--I had been diagnosed with depression and was taking antidepressants. I had never been hospitalized for depression and was doing well on my medication.

I called the company and asked for more details regarding why I was turned down. I asked, "Do you never accept people who are on medications?" The agent said that yes, they did accept people on medications. I couldn't get a satisfactory answer as to why I would be turned down if that was the case, especially since I was generally in good health. The conversation made me wonder if I was being discriminated against since my health problem was a mental health problem as opposed to a problem with my physical health.

I wrote a letter to that company voicing this very concern, but I also wrote to the Commissioner of Insurance for North Dakota. I heard back from the Commissioner of Insurance, saying, to my dismay, that in regard to providing health insurance coverage, it wasn't against the law to discriminate against people with mental health problems in North Dakota. He gave me a list of several other companies to try.

However, complaining can pay off. I got a call from the company that had turned me down, saying that they had decided to provide coverage for me.

As I see it, the moral of the story is to not just accept it when an insurance company won't give you coverage or denies a claim. Call the company, write to them, and make them try to justify their decision. Sometimes companies will just deny things and hope that people won't complain, and they might reverse their decision when people do complain. Write to a higher authority such as the Commissioner of Insurance or the equivalent for your state if you can. I did that in one other instance besides the situation described above. For some reason or another, my insurance company wouldn't pay for a psychiatrist's visit. It turns out they weren't even obligated to pay for that service under my plan at that time, but after writing to the Commissioner, for reasons described as "goodwill" they paid for half of it. I am not saying complaining works 100% of the time, because I have heard of cases where it has not. However, my experience has been that it works often enough to make it worth the trouble.