Your claims and Medical Insurance in South Carolina

A medical insurance in South Carolina will help you pay for medical expenses that many people don’t have the funds and finances to answer for. While this might seem like a saving grace for most, the truth is that not every claim will be granted financial assistance. Why is that? Well, when you buy your insurance, there will be certain terms, exclusions, limitations, and coverage that will set the boundaries for what your insurance provider will be willing to pay for.

So, what happens when you make a claim at that gets rejected? These pointers should give you a better idea on the next steps you should take.

What to Do When Your Claim Gets Rejected

  1. Ask for Assistance – Odds are, your locality has some sort of insurance office that handles these complaints. This should have been discussed when you first purchased your medical insurance in South Carolina. You can approach your local insurance government office to ask if there’s anything they can do to assist you in order to get your insurance provider to agree with your claim. You can either make an appeal for your provider to re-evaluate your request or you can appeal that they settle for an amount less than you originally specified.
  2. Internal Review – This is the first step of the appeal process and involves sending your insurance provider a written appeal for reconsideration. Your internal review should result to a final decision and outcome within 30 days for a service you’ve yet to avail or within 60 days if your appeal is for a service that has already been done. If in case your insurance provider still returns to you with a negative decision, you can opt for an external review.
  3. External Review (Third Party) – If your insurance provider still rejects or denies you coverage after your internal review, you can opt to go for an external review which will involve the professional services and perhaps even legal services of others not previously involved in the process. This will be your last chance at getting your insurance provider’s financial assistance, after which you can choose to put things in the hand of the law or to simply pay for all of the expenses on your own and accept the decision of your insurance provider.

When filing a claim here, make sure you know what coverage you have and the limitations that apply to your medical insurance in South Carolina. This way, you can keep yourself from having to deal with the mess involved in a rejected claim.