What To Do If Your Child's Special Needs Health Care Claim Is Denied

Caring for a child with special needs is expensive. From doctor visits to therapy appointments, you rely on your health insurance to cover life-saving and life changing treatments. What do you do, though, if the insurance company denies a claim? 


Call the Insurance Company


Maybe someone accidentally typed in a wrong code or the doctor's office didn't submit the claim in a timely manner. A simple phone call to the insurance company could set the record straight.


Follow the Appeals Procedure


Your insurance company has an appeals procedure that might help you. Be sure to document every phone call including the names and phone numbers of the customer service reps to whom you speak, the calls' dates and times and what you discuss.


Submit Written Treatment Notes and Invoices


Written words hold more weight than verbal words. Ask the doctor or therapist to focus on how the procedure, treatment or equipment is medically necessary.


Document Your Child's Needs


You don't want to spend time educating the insurance company, but that's sometimes exactly what needs to happen, especially if your child has a rare disability. Track your child's daily activities, needs and limitations as you detail your child's specific condition and influence the insurance company to pay the claim.


Consider Paying Out-of-Pocket


Rather than fight a denied claim that's for a service your child needs, pay for it yourself. You won't want to take this measure, though, if an ongoing service continues to get denied. In that case, contact a lawyer.


Contact a Lawyer


When all else fails and your child needs ongoing services or the denial of a claim threatens your child's life, contact a lawyer. He or she can take action that protects your child's health and quality of life. Choose a lawyer with specialized knowledge of special needs to maximize your chances of winning the case.


Your precious child with special needs can receive the medical treatment, therapy, medication and equipment he or she needs. When claims are denied, follow these steps. Ask your insurance agent for additional tips, too, as you fight for your child.

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