Uncovering Health Insurance Claim Denials: How to Access Insurer-Doctor Communication
Patients have the right to access their health insurance claim file, which includes phone call conversations between their insurer and doctor, to understand why their claim was denied. Little known federal regulation requires most insurance plans to give patients the opportunity to review these documents free of charge. Patients need to provide specific information, including their name, plan ID, case number, and dates of appointments. The information in the claim file can be a "treasure trove" for patients and can help them appeal the decision or uncover errors made by the insurer.