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3 things to do if your health insurance claim is denied

On Behalf of | Dec 15, 2017 | Delayed And Denied Insurance Claims | 0 comments

You expect your health insurance provider to pick up at least some of your medical claim, whether it is for an emergency operation or a routine visit to the doctor. But sometimes that is not the case. In fact, according to Forbes, 200 million health insurance claims are denied each year. That is a disheartening statistic that you may be a part of.

How do you deal with a health insurance claim denial? Is there any way to appeal one? Read below for a guide to responding to a rejected health insurance claim.

1. Figure out the reason for the denial

Before you appeal your claim, you must understand the reason for the rejection. Some potential reasons include:

  • Insufficient details on test or procedures
  • Inaccurate or incomplete insurance information
  • Coding mistakes or omissions
  • Lack of medical necessity

Sometimes you may have put down the wrong insurance ID number or misspelled your name. Even if it is a more complex problem, an appeal is still possible.

2. Gather evidence

Once you find out why your insurer did not approve your claim, it is time to gather evidence to refute the denial. For example, you may want to request referral or prescription information from your doctor. This can help you prove that your claim is valid.

3. Appeal your claim

Your denial letter should include details about how to appeal the decision. If not, you can contact your insurance provider directly and ask how the process works. This usually involves writing a letter or filling out a form. Re-applying for your benefits means you will be more likely to receive approval.

These three core steps will get you on the path to getting the health insurance assistance you deserve. Sometimes you may need to appeal multiple times, but it is worth it to keep trying. In order to make sure you get your appeals correct, you should talk to a lawyer who practices health insurance law.