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What should I do if my health insurance claim is denied?

On Behalf of | Apr 11, 2022 | Delayed And Denied Insurance Claims | 0 comments

Your health insurance company is supposed to take care of you when you get injured or sick, right? While that’s certainly the hope, the sad reality is that many times insurance companies deny or delay paying claims. After all, they’re in the business of making money, which means they’re going to look for just about any reason they can find to justify a denial.

So, what do you do if your health insurance claim is denied?

This is a good question that many people need answered because for many individuals simply accept their insurance claim denial and move on with paying everything out of pocket. Don’t do that. There’s an insurance appeal process that you can follow, and successfully appealing your claim may be easier than you anticipate.

But where do you start with your insurance appeal? Let’s look at some of the steps that you’re going to have to take along the way:

  • Figure out the reason behind your claim’s denial: When your claim is underpaid or is denied, you should receive an explanation letter from your insurer. This letter will spell out how your benefits helped cover your medical expenses or why they didn’t cover your treatment at all. If you have questions about how your benefits were applied, then you can call your insurer to discuss the matter further. If you still can’t achieve the outcome that you want, then you may need to consider a formal appeal.
  • Know the deadline for filing: Insurance companies have tight timelines for filing an appeal. If you miss the window, then you’ll lose out on an opportunity to seek the benefits you deserve. So, read your policy to figure out when you need to file your appeal.
  • Gather evidence to support your claim: If you’re going to appeal your denial, then you’re going to need evidence showing that the insurance company should have covered your medical care. You might have to talk to your doctor to get a statement indicating that your treatment was a medical necessity and why. You may even have to turn to scientific research that speaks to your medical condition and how it should be treated.
  • Write your appeal letter: This statement should be concise and should avoid emotional offloading. Instead, specify your condition, the treatment you received, and why you think it should’ve been covered. Then you can attach any supporting documentation that you may have, including a letter from your doctor speaking to the necessity of your treatment.
  • Be prepared for more rejection than you anticipated: A lot of success in appealing an insurance claim denial is chalked up to perseverance. The insurance company is going to try to wear you down so that you just accept whatever answer they give you. But if you’re prepared to keep pushing through the rejection, then you’ll have the motivation and energy to continue to fight for a just outcome.

Do you want an advocate on your side?

Although these insurance appeals aren’t necessarily formal legal proceedings, they do take extensive knowhow about insurance policies and practices if you hope to reach a favorable outcome. That can be a stressful and overwhelming thought. But skilled legal professionals like those at our team are here to help guide you through the process and assist you in crafting the persuasive arguments that you need. So, if you want to know more about how to handle your case and what we have to offer our clients, then please consider browsing our website further.