Here’s how to fight back against medical debt & appeal your denied medical claim

Whether you are getting contacted by a collection agency over medical debt, or you are dealing with your health insurer over a claim that’s been denied, we want to help. News4JAX found out from Consumer Reports what you can do to fight back.

Fight back against medical debt

More than 40 million people have unpaid medical bills sent to collections. And get this: Consumer Reports says almost half of those bills have at least one error.

If you’re contacted by a debt collector for a medical bill you believe to be wrong, never pay it right away. Instead, CR says to take these steps:

Step one: Gather as much info as you can, including the name of the collection agency, the person you’re speaking with, their phone number, postal address, email address, and as much information about the bill as possible.

“There are a lot of scams out there, so doing this can deter any phony debt collector,” explained Consumer Reports Investigative Reporter Lisa Gill.

Step two: Ask the debt collector to send verification of the debt. You can expect to receive the information in the mail within about five days of your request.

If the verification letter shows an error, file a dispute in writing by either email or certified letter within 30 days, or else the collection agency will assume the debt is valid.

There might be a statute of limitations on how long a debt can be collected. Consumer Reports says do not pay any part of it until you’re sure you still owe the money.

Appeal your denied medical claim

Are you unsure of what to do if your health insurance provider refuses to cover a test, treatment, or medication your doctor says you need? Before you dig into savings and pay out of pocket, Consumer Reports says you have a guaranteed right to appeal – and it’s not hard to do.

According to a report from Kaiser Family Foundation, about 18 percent of in-network claims from people insured through an Affordable Care Act plan were denied in 2020.

But that doesn’t mean you should immediately pay for the treatment yourself, or worse, go without care. Consumer Reports says you have the right to appeal the decision, and that goes for Medicare or private health insurance.

Step one: Your first step is to check for mistakes. Call your insurance company to make sure there wasn’t an error with your claim.

“Mistakes can and do happen at multiple points in the claim filing or pre-authorization process, and they’re often relatively easy to fix once you identify them,” said Gill.

If there isn’t a mistake, ask to speak to the reviewer behind the decision and request an explanation. You’ll need this information for your next step.

Step two: File a formal appeal -- specifically stating that you disagree with the decision.

“You’re going to ask your doctor to help to write a letter that explains the necessity for the procedure and includes as many supporting documents as possible – like your medical records and treatment studies and any communication with the insurance company,” Gill explained.

Doctors are used to this, so Gill says don’t be afraid to ask.

Step three: The next step might be the hardest: Waiting. It could take 30 days or longer for an answer, but if you need the denied treatment right away, make sure you request an expedited review.

“So, if you get a letter that the insurer is still choosing to deny the claim, both Medicare and the private insurance are required by law to give you the reason in writing -- and tell you how to appeal the decision for review by an independent third party,” said Gill.

If you get your insurance through your employer, consider asking your company’s human resources department to help. If your claim was denied by Medicare, Gill says you can consider getting legal help to have your case heard before a judge.