Having Health Insurance Coverage means you are protected. But what happens when you actually need to use that protection? For many Americans, dealing with the actual health insurance coverage can be a complicated issue, and stressing.

If you need to use your Health Insurance, you should know a series of steps that will ensure you will get the health care you need. Having insurance doesn’t mean that you will go to the doctor and everything will be covered. Even the smallest issues and consults can become a significant expense if you don’t know how to handle your health insurance company claims.

Here are a series of things you need to keep in mind when handling a Claim:

Known your plan, and what does it entitle to. Not only you should know what do you have coverage access to in your plan, but also the requirement in order to receive that coverage. The most important advice we can give you is: Make sure the treatment you are planning on receiving is covered under your insurance before treatment is received.

A good way to start is by getting a copy of your coverage. It may be an insurance policy, a booklet of coverage, a Summary Plan Description, or a chapter in an employee benefits manual. The health plan description will cover twenty to thirty pages or more.

When filling a claim, make sure you have all the necessary information available, and make sure this information is reliable, and verifiable. Some health plans often deny or return pre-authorization requests because of missing data.

Good documentation can also help you avoid denials. While it may seem paranoid, write down the name of every person you talk to in reference to your health insurance problems and keep backups of all correspondence and paperwork. This documentation can be invaluable if an insurer denies your claim.

If your claim is denied, find out why. Did you forget to fill out something, to attach some information? Your health insurance company should be able to tell you why they denied the coverage, and usually, if you make the right appeal, you will be able to get it.

Your doctor can help you if you have been denied coverage. Most plans grant or deny treatment based on whether medical intervention is necessary for your well-being and whether the treatment you seek is appropriate for your health condition.

Appeals

Every plan should have a clear appeals process that you must follow to the letter. You may only have a limited time from the date you had the procedure to get an appeal under way, possibly only 60 days. Depending on your plan's procedure, you may have to start with a phone complaint and then move to a written appeal.

There are two methods of appeal: internal and external. The internal appeal is to the insurer itself; an external appeal is to your state department of insurance or other governing body.

If you need Additional Help

Each state has its own department of insurance that works to ensure that consumers are protected and that the regulatory processes of the insurance companies are fair. So, a call to your state's insurance department might help.