Insurance Claims

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Claim DeniedFiling an insurance claim is usually preceded by some sort of traumatic event in your life, whether it has to do with medical needs, home or auto damage or theft, or some other unfortunate circumstance. The last thing you want in these times is to have to fight with your insurance company to get them to pay you. There are steps you can take at every point in the claims process to help make this course timely and painless.

Not surprisingly, finding a good insurance agent can help to make the stressful process of filing a claim less aggravating. You find out how good your agent really is when you need to file a claim. If you are not satisfied with the level of service you are receiving from your current agent, we know several who are well known for far exceeded their clients expectations.

Angelyn Treutel, an independence insurance agent in Bay St. Louis, Mississippi says, “People who do some planning are going to get through the claims process most easily.” She says that technology has helped smooth this process as well, since smart phone cameras are so readily available, insurance companies have their own apps for many of these devices, and there are plenty of online tools and resources to help prepare before a claim, submit claim information, and support your case if your claim is denied.

Health Insurance

The most complicated type of claim is a health insurance claim because of the complex relationship between health care providers and insurance companies. Plus, many doctors and hospitals provide special deals for each insurer, so you never quite know how much you’re going to pay for something until you are billed. Every insurance plan has such different policies and requirements that it would benefit you immensely to read through your plan thoroughly and make sure you are clear on every aspect of your coverage prior to having to make a claim.

If you know what your policy does and doesn’t cover and what it requires, you can avoid many hassles in the claims process. For example, does your insurance require preapproval before you can go to certain facilities for care? You don’t want to have to wonder whether or not you will be covered if you have to make a quick trip to the emergency room in the middle of the night. How much are your out-of-pocket expenses for out-of-network providers? Co-pays and treatment costs can be significantly higher for out-of-network doctors, and the claims process could be complicated by the fact that the provider may not have an electronic claims link to the insurer because it is out of the insurer’s network.

If you have any questions about your policy, out-of-network care, your costs, other requirements, etc., call your insurer and speak to a representative. Taking note of the exact date and time you called, who you spoke with, and a brief summary of your conversation will help in the event of misinformation if you ever need to appeal your case.

Furthermore, if you have a claim, compare the form you get from your doctor to the doctor’s bill with the insurer’s explanation of benefits (EOB). Pat Pane, a medical claims specialist in Wilmington, North Carolina, recommends to, “Never pay a doctor’s bill until you get your EOB,” because you may have been billed before the doctor’s office submitted the claim to the insurer.

Additional Tips:  If your claim is denied, the reason could be something as simple as an administrative problem, such as typing in the wrong codes somewhere along the paper trail. If reviewing these items doesn’t help, rather than wasting your time with repeated phone calls over the following weeks and months, go straight into the appeal process. This process forces your insurer to respond in a timely manner. The appeal procedure is usually outlined in the denial letter you receive from your insurer. Call your state insurance department to request guidance prior to filing an appeal, and be sure to gather all evidence necessary to support your claim. For example, it will be helpful to have something stating why the procedure was medically necessary or why you had to go to out-of-network care. If necessary, seek help from a claims specialist. According to, “These professionals can help organize your claims paperwork, deal with the insurer, spot errors, collect extra documents from doctors, and help you file an appeal.” A typical cost for their help would be around $130 to $150 per hour.

Homeowners Insurance  

With today’s advanced technology, taking an inventory of your home is much easier than it used to be. Rather than writing down long lists of everything you own and storing it in a safe deposit box, you can take a video of every room in your house and save it in your email! There are also a few apps on the market geared specifically toward managing your home’s inventory, two of which are the Insurance Information Institute’s app at, and an app from the National Association of Insurance Commissioners at

If you have a claim on your home, be sure to get as much information and document as many details as possible. If the situation permits it, take pictures of the entire situation and take very detailed notes, as traumatic experiences can often make this information difficult to recall later on. Furthermore, if you can take pictures of the cause of your damage, such as a water leak, it can help lessen the questions you may be asked about your losses. Lastly, take whatever measures you feel necessary in order to prevent further damage, but don’t clean up the scene or make any major modifications until the insurance adjuster has surveyed the damage.

If the claim is small, it may be more beneficial to pay for it yourself rather than filing a series of small claims and risking getting dropped by your insurer, having your rates increased, or losing out on valuable discounts. If you do file a claim, be sure to maintain consistent follow up with your insurer, in case there are any additional steps you need to take that may hold up the process. It may also be a good idea to have a contractor and the adjuster meet at the damage site, in order to make sure they can evaluate the damage from the same perspective.

Your insurer may reimburse you for hotel stays, meal costs, and other extra living expenses if your damage requires you to be out of your house temporarily, so be sure to save all of these receipts, along with any for supplies you might buy to help contain the damage.

Additional Tips:  All state insurance departments have a free service dedicated to helping you through your claims process and to make sure you get everything you’re entitled to under your policy. According to John Huff, Missouri’s director of insurance, his department recovered an extra $19 million in claims for consumers who suffered damage in the recent Joplin tornado. Also, your state insurance department may set up a special appeals process if your area ever faces a major disaster. Even without a major disaster, your state can help get a claim paid quickly. Montana’s commissioner of securities and insurance said, “It’s amazing how quickly many claims get paid once you contact us…And sometimes just threatening to contact us can help.”

Auto Insurance

Similar to documenting the damage in a homeowners claim, it is important that you take photographs and notes of all damage in an automobile accident too, rather than just exchanging contact and insurance information. This information should include photographs of your car’s damage, the other car’s damage, the scene of the accident, the other driver’s license plate, and the other driver’s registration and insurance card, as well as contact information for any witnesses to the accident. Also, if a police officer comes to the scene and writes up an accident report, obtain the report number for your claim as well. Then, contact your insurer or insurance agent immediately.

Some insurance companies have apps that can help you file your claims, upload pertinent documents, and generate an accident report to help with your claims process. Whether your insurer has these additional resources or not, be sure to try to follow its claims process as closely as possible, so you don’t delay the turnaround time. One way to expedite this process is to take your car to a repair shop that is on your insurer’s recommended list – these facilities often have claims representatives on hand to deal with your situation, as well as rental car service so you can be on your way quickly.

Additional Tips: If your repair shop estimates the cost of fixing the damage to be more than the appraiser’s estimate, provide your insurer with a detailed estimate from the shop. Sometimes these cost differences are because your shop wants to use the original manufacturer’s parts, while the insurer covers after-market parts instead. If your insurer says your car is totaled, make sure you have accurate, updated information on the value of your car compared to others from the same year and in similar condition, to make sure your car isn’t being undervalued. It may also help to get your insurance agent or your state’s insurance department involved in order to help speed up the process or ask any questions.

If you have any questions about filing a claim or making sure your claims process goes smoothly, give us a call. We are happy to help.

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