What should I do if after I am enrolled I discover that my provider is denying my claims?
First, we would need to determine what coverages or treatments are being denied and for what reason. Second, we could go through an appeals process with the insurer to get the coverage denial reversed. Third, if the appeal process did not work, we could seek alternative coverage with another insurer. This is where the individual v. “group” coverage comes into play and makes a difference. With individual insurance, depending on the conditions, it may be difficult and expensive to change coverage whereas, for small group insurance in California, you could change as of the first of the following month to another carrier that may cover those items that are currently being denied with your present insurer.