Advertisement There are options when health insurance denies your claim | Here’s where to go 69.7% of cases received by Maryland Insurance Administration get initial decision reversed or modified Editorial Standards ⓘ

When health insurance companies deny a claim, policyholders have options. Here is what to do.Rebecca Strauch was told a procedure was medically necessary and would be life-changing for her.However, her insurance denied the claim.’What is the point of insurance?'”I was shocked because, I mean, at this point, what is the point of having insurance if something was denied?” Strauch said.For the past 13 years, the married, working mother of three young children had been suffering through severe daily pain. The agony often forced her to cancel plans.”I was diagnosed with pelvic congestion syndrome, and it was an ovarian embolization,” Strauch said.Then, hope came when a specialist suggested a new kind of treatment.”The day at the hospital, when I was getting the procedure, they told me, ‘Your life is going to be so much better because you are not going to be in so much pain,'” Strauch told WBAL-TV 11 News Investigates.The surgery worked, and she got her life back — until a new, unexpected, expensive problem developed. Strauch told WBAL-TV 11 News Investigates that her out-of-pocket costs were more than $34,000.”I still don’t know if all the bills have come in yet,” Strauch told WBAL-TV 11 News Investigates.Navigating the health insurance appeals processStrauch filed an appeal with her insurance company. The appeals process can be maddening and frustrating, leaving policyholders feeling completely boxed in. Strauch, however, did not give up.”I got the letter in the mail and it just basically said they were not going to approve it,” Strauch told WBAL-TV 11 News Investigates.She then contacted all her doctors to make sure the office paperwork was filled out correctly. The information included physical therapy appointments, reference numbers, doctors’ notes, referrals, CT scans and medication receipts.”Then, that was denied,” Strauch told WBAL-TV 11 News Investigates. “I was frustrated because, I mean, I know that things like this happen, but what can you do when something is denied? I was very upset. I didn’t know what else to do.”Strauch doubled down and collected some 60 pages of medical documents. Over almost 10 months, she kept sending the material to her health insurance company.”I had my personal letter stating everything that I’ve tried. It just (was) basically begging for approval that I needed it and that it was medically necessary,” Strauch told WBAL-TV 11 News Investigates.Where to get help from the stateStrauch could have sought help from two state agencies: the Maryland Insurance Administration and the Health Education and Advocacy Unit at the Maryland attorney general’s office.”We have independent medical teams that take a look at that, and honestly, if a case does get to us, we have a really high success rate of helping consumers,” Maryland Insurance Commissioner Marie Grant told WBAL-TV 11 News Investigates.| CALL MIA: 410-468-2000 | File a complaintBased on the most recent data available from 2023, the Maryland Insurance Administration said that, for the cases that it receives, the initial decision was reversed or modified 69.7% of the time.The attorney general’s office has a specialized team in its Consumer Protection Division called the Health Education and Advocacy Unit, which offers free mediation for denied coverage from private health plans.| HEAU HOTLINE: 410-528-1840’I’m very happy’So, Strauch appealed through the state, and, remarkably, during her interview with WBAL-TV 11 News Investigates, she received official written approval from her insurance company.”The appeal went through, and our responsibility is now $1,339.57,” Strauch said. “This is one step closer to everything being finished. So, I’m very happy.”The lesson is to be persistent, meet deadlines and, if all appeals are exhausted without success, seek legal advice as a last resort.