health care claims

How to Assist With a Health Insurance Claim Dispute


Employee benefits professionals routinely assist employees in resolving disputes over denied or improperly paid health insurance claims. Next to the annual open enrollment and benefits fair, these encounters are the most one-on-one contact benefits pros have with employees. Therefore it is extremely important that these interactions are handled with professionalism and understanding.

To make sure that happens create a checklist or guide you can use every time you assist with a claim dispute. You can use an existing checklist like the one from ehow and add to it. For example, include a first step on how to prevent a claim dispute from happening and a final step of filing an appeal with the state department of insurance. You can also share these customized guides with employees, in the form of a brochure, as part of the new hire benefits package, as a newsletter article or on the company website.

Creating a claims dispute resolution guide or checklist is not difficult. Working with an upset and confused employee is. Therefore, it is important to know what to expect and establish some guidelines and expectations for the employee and you.

What to Expect From An Employee Disputing an Insurance Claim
  • Expect them to be upset
  • Expect them to talk too fast
  • Expect them to leave out relevant information
  • Expect them to want you to agree with them
  • Expect them to want an immediate resolution
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