Today’s column centers upon Part 2 of Henrietta Hysterical’s question concerning insurance company appeals. Combined with recommendations from last week, most of us should be able now to preserve funds that might otherwise go to pay unnecessary medical bills. If your insurance company, whether an HMO or a PPO, refuses to pay some of your expenses, then please file an appeal in order to protect your nest egg.

First, alert your insurance company that you’re filing a complaint or an appeal; however, be sure to follow the process and procedures set up by your own health plan. Be sure to appeal to your state Department of Insurance, members of Congress, and the US Department of Labor. (If the problem is a Medicare issue, contact the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore MD 21244-1850 or call 1-800-633-4227.) While an abundance of contacts are waiting in the wings to jump in and help, one of the first (and best) might be your employer. The Department of Labor reminds us: before we file, be aware of the Employee Retirement Income Security Act of 1974 (ERISA), a law that protects health and disability benefits and sets standards for those who administer your plan. Among other things, the law and rules issued by the Department of Labor include the processing of benefit claims, the timeline for a decision when you file a claim and your rights when a claim is denied. Thus, your supervisor just may be the best party to act as your advocate, especially since most of the hefty HMO bills are coming from that person’s company pockets. I expect both your bosses and your benefits department want to get their money’s worth, and an insurance company is hesitant to lose future business.

Secondly, state departments of insurance are super allies. Each state has its own laws and regulations for all types of insurance, as well as those people whose job it is to enforce the law. I urge you to immediately write this official should you encounter a problem with your health care provider.

Check other providers’ costs, such as the price for similar procedures with other locations/specialists. Insurance companies often refuse to pay for certain services, noting they’re not “reasonable and customary” fees. With legwork to prove that these fees are commonplace and your physician and hospital charge no more (exhorbitantly) than others within the area, the company generally coughs up the money. Another approach is to ask a respected medical expert outside your network for his opinion on the fees; if Doc Pro agrees they aren’t out of range, his judgment may help your case.

The Patient Advocate Foundation (PAF) is a top-notch group whose mission to help folks who’re facing or involved with in a medical crisis. PAF deals with everything from job discrimination for the ill to helping to get insurance companies to pay medical bills. This non-profit advocacy/activist organization first tries “nice,” then comes out swinging on our behalf if all else fails. Check out all PAF offers at www.patientadvocate.org or call 1-800-532-5274. It may be just what the doctor ordered.

A little-known secret is when challenged an HMO may overturn its own decision. And finally let’s not forget the most important ammo of all — a lawsuit. While I generally don’t advocate litigious action, sometimes it’s necessary. However, I’ll hold off writing about this last-ditch effort for a future column.

Editor’s Note: Ellen Phillips is a retired English teacher who has written two consumer-oriented books. Her Consumer Watch column appears on Saturdays in the Business section of the paper. An expanded version is at www.timesfreepress.com under Local Business. E-mail her at consumerwatch@timesfreepress.com

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