I never thought about changing my Medigap until recently since my premium has skyrocketed. I met with a local agent who helped me apply for the same plan but with another company whose premiums were much lower, but last week I got a letter saying my application was denied for a health condition that I don’t even have! Should I give up on trying to apply or can I fight this?
-Dean (West Palm Beach, FL)
Being denied coverage is a frustrating experience, especially if the grounds for denial were unfounded. The good news is that you can appeal this decision, but it will cost you some time and effort.
First and foremost, be sure to read that denial letter thoroughly as it will have several important pieces of information on it. Denial letters are not typically shared with your insurance agent for privacy purposes, so there are some steps you may have to take on your own to get the appeals process going.
The letter will include a description of what prompted the insurance company to issue the decline and how long you have to appeal the decision. Do contact the appeals department as soon as possible since this can be a lengthy process. In some instances, you may have to contact your physician to obtain a statement or have them update your medical records.
As you gather the documentation needed, make copies just in case anything gets lost. Each time you call in, be sure to ask what else is needed of you, what the timelines are, and when they will make a final decision. Take detailed notes of who you spoke with and when- this will help you stay on top of the process and hold them accountable to their timelines.
Keep in mind that the Fair Credit Reporting Act (FCRA) requires companies to look over your appeal and resolve it within 30 days. The resolution does not guarantee that they will ultimately accept your insurance application, but they may change their decision if there is sufficient evidence that you were wrongly denied.
If the appeal is denied, you can always try to apply with a different insurance company, but keep in mind that they will still see the negative items on your report if you were not able to get them removed. I wish you the best of luck with everything, Dean. I hope this helps!
–Your Medicare Advisor
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Or find out who put in the condition and charged for it.