Negotiating Claims with Your Insurance Company: Helpful Tips

Many Americans put their faith in health insurance companies, paying hefty premiums to be protected in the event of catastrophic or chronic illness.  Too frequently, in times of need, their claims are denied for technical or procedural reasons, or no good reason at all.  A recent article published in CNN Medical News chronicles the story of one family's unjust treatment by an insurer, and includes the following advice for leveraging your position and negotiating more successfully with insurance companies regarding claim denials:

  1. Get help.  Your doctor, hospital business office, and employee benefits office can be much more powerful than you are. 
  2. Be persistent.  File appeals again and again, and to several different levels until you get a favorable resolution. 
  3. Use the right words.  Certain words, like "cosmetic," or "to enhance esteem," may trigger a denial, while appeals that include specific problems with "biting," "chewing," or "swallowing" may work to your advantage. 
  4. Ask your doctor to try again.  If a particular drug or procedure serves two purposes (for instance, it enhances the effectiveness of your chemotherapy, and also treats your anemia), then mention the second when you appeal a denial of the first. 
  5. You may need a lawyer.  The threat of a lawsuit with attorneys copied on your correspondence may get your claim the close attention it deserves.

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Uninsured Get Sicker While Waiting for Medicare: New Study

New Medicare beneficiaries who have previously been uninsured -- particularly those with diabetes or cardiovascular disease -- cost the Medicare program significantly more than those who were insured earlier, according to a new study in the New England Journal of Medicine

According to researchers, the costs associated with treating chronic disease complications are much greater than the costs of routine disease management or prevention.  Because most previously uninsured enrollees tend to comply with physician visits and medical procedures once they are eligible, researchers believe they probably would have addressed their health problems earlier had they been insured.

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Defendants Can No Longer Compel Settlements To Be Secret

For many years, hospitals, pharmaceutical companies, insurance companies, and defendants generally have settled cases with the caveat that the settlement and facts of the case be kept secret forever. Although their wrongdoing may have seriously, if not fatally, injured victims, their goal was to shield the rest of the world from their misconduct. In a recent decision governing the professional conduct of lawyers, the District of Columbia Office of Bar Counsel has made clear that a settlement agreement “may not compel counsel to keep confidential . . . public information about the case, such as the name of the opponent, the allegations set forth in the complaint on file, or the fact that the case has settled.” Bar Counsel rightly determined that, among other things, suppression of this information works to keep important information from other victims who deserve to know that their injuries may have been caused by the wrongdoing of others.

For the complete text of the rule governing lawyer conduct, please click here.

Fines for Lapsed Automobile Liability Insurance in DC, MD and VA

D.C., Virginia, and Maryland have specific requirements for motorists if their automobile liability insurance lapses.

D.C. requires all vehicle owners with lapsed or expired automobile liability insurance to immediately surrender their license plates and registration. In addition, all drivers who are stopped by a police officer in the District of Columbia are required to display license, registration, and proof of insurance, or face a fine.

Virginia allows uninsured vehicles to register and be driven, at the driver’s sole risk, for a $500 fee. Insurance carriers notify the DMV of vehicles whose insurance has lapsed. Uninsured motorists who fail to pay this additional fee will have their licenses and registration suspended.

Maryland uninsured drivers can lose their license and registration and even be required to pay a $150 fine for the first 30 days and $7 per day after that.

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Do You Understand the Terms of Your Auto Insurance Policy?

In order to protect your rights and your personal assets, every driver needs to understand his or her automobile insurance policy BEFORE being involved in an accident.

Bodily Injury and Liability Insurance:
 This term defines how much coverage the insurance agency will be liable for if you cause an accident occurs and someone is injured. Usually split into two numbers, the first covers the maximum they will pay for one person’s injuries and the second is the maximum they will pay for all injuries sustained in the accident. 

Almost all states require a minimum level of bodily injury and liability coverage.  Examples of such include:

  • District of Columbia: $25,000/$50,000
  • Maryland: $20,000/$40,000
  • Virginia: $25,000/$50,000

Collision Insurance: This term defines how much an insurance company will pay for damage to your vehicle if it is damaged by another vehicle or fixed object (tree, stop sign). 

Comprehensive Coverage Insurance: This term, sometimes called “fire and theft” coverage, covers all damages to your car that are not caused by a collision. For example, it may cover tornadoes, floods, fire, theft, hitting a deer, etc.

Car Rental: If your car is in the shop for more than a day, many insurers will pay a per diem for your rental car while you wait for repairs, if you have this coverage.

Full Glass Coverage: Full glass coverage eliminates any deductible payments for broken glass on the car. In most states there is no deductible for windshield damage (because it is illegal to drive with a broken windshield), but for all other window damage to the car, you will have to pay the deductible for comprehensive coverage. Full glass coverage is an extra feature that you can buy to eliminate the deductible payment.

Medical Benefits Coverage: Covers medical expenses that you and your passengers sustained during an accident, no matter who was at fault.

No Fault Insurance: No Fault insurance currently exists in 12 states and Puerto Rico.  Essentially, "no fault" means that, if injured, you can recover certain damages from your own insurance company.  However, you cannot sue the other party unless your injuries rise to a certain level.  If you  live in Florida, Michigan , New York, New Jersey, Hawaii, Kansas, Kentucky, Pennsylvania, Massachusetts, Minnesota, North Dakota, Utah, or Puerto Rico, be sure to ask you insurance agency about your state's laws.

Personal Injury Protection: Personal Injury Protection (PIP) covers medical and rehabilitation expenses, work loss, funeral, and other expenses incurred by you, your family, or passengers in your vehicle. PIP pays for those damages no matter who was at fault. 

Uninsured or Underinsured Motorist Coverage: This coverage pays for your injuries in a crash where the other motorist either does not have insurance or does not have enough insurance to cover your damages. For instance, if the other driver has the minimum coverage in Virginia ($25,000) and your damages are $75,000, his insurance company will pay for the first $25,000 of your injuries and you may or may not be able to collect the remaining $50,000 from him. If, however, you have underinsured or motorist coverage, you can make a claim against your uninsured motorist coverage carrier for the remaining portion. This coverage often covers hit-and-run drivers as well.

Resources:  Virginia Auto Insurance Requirements
                        Virginia Auto Insurance Consumer Guide
                        DC Auto Insurance Requirements
                        Maryland Department of Motor Vehicle
                        Maryland Auto Insurance Consumer Guide

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Can your credit score affect your automobile insurance premium?

Not just your driving record and type of car you drive can affect your insurance rates. 

Consumer Reports has found that insurance companies are now using bill paying and loan data collected from major credit companies to determine what your monthly payment will be, in some cases raising rates as much as 25-47%.

Even though the data from which these scores are derived is often out-dated and inaccurate, most states allow insurance companies to use it for credit scoring purposes. Consumer advocates are trying to get legislatures to ban this sort of scoring, but so far they have been unsuccessful. Lobbyists for the insurance industry, on the other hand, have succeeded in stopping such legislation in Colorado, Delaware, and Minnesota.

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