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  4.  » Steps to take when your health insurance claim is denied

Steps to take when your health insurance claim is denied

On Behalf of | Oct 12, 2022 | delayed and denied insurance claims | 0 comments

A denied health insurance claim can feel like a punch to the gut. Expenses that you hoped would be covered are now dumped on you with the expectation that you’ll pay quickly and, if you’re like most Americans, you don’t have thousands of extra dollars sitting around to pay off unexpected medical debt. This means that your financial stability can be severely jeopardized, which can wrap you in a blanket of stress that can be difficult to escape.

Fortunately, you don’t have to sit down and accept what the insurance company has told you. Instead, you can fight back to ensure that you’re getting everything you’re owed under your insurance policy.

But how do you fight back against your insurance company?

There are steps that you can take right now to better position yourself for success when squaring off against your insurance company. This includes:

  • Reading your policy to make sure that you have a full understanding of what’s covered and what isn’t. These documents are usually long and a little difficult to understand, so make sure that you’re giving yourself enough time to soak it all in.
  • Making sure you have a clear understanding of why your claim was denied. Although you should be provided with a written explanation from the insurance company, call them and talk to someone about it if you need further clarification.
  • Gaining clarification on how long you have to appeal your denied claim. This information should be in your policy but calling the insurance company can help solidify the timeline during which you have to submit your appeal.
  • Getting a letter of necessity from your doctor if your claim was denied because the services provided weren’t deemed by your insurance company to be necessary to treat your condition.
  • Gathering other evidence to support the necessity of your treatment. This might include turning to medical studies that speak to your medical condition and the treatment that you received, or it might involve talking to professional organizations and societies that focus on studies pertaining to specific diseases and injuries to learn more about why your treatment is necessary.
  • Drafting a targeted appeal letter that speaks directly to the reason for your claim’s denial. You can attach your letter of medical necessity and any other supporting evidence to this letter.
  • Refusing to give up. Even if your appeal is denied, you still have legal options for seeking out the compensation that you deserve. This may include filing a claim with the insurance commission. Again, you’ll just want to make sure that you’re able to identify why your initial appeal was denied so that you can target your arguments moving forward.

As you can see from this list, there’s a lot to do when you want to appeal a denied insurance claim. Although it can seem daunting at first, you shouldn’t let the stress of it all overwhelm you to the point where you don’t take action.

Advocates are ready to fight for you

In fact, if you’re going up against an insurance company, you need to make sure that you know the law and how to use it to your advantage. You also need to know how to make strong legal arguments that maximize your chances of succeeding on your appeal.

If you want that kind of assistance on your side, you may benefit from reaching out to a legal professional to discuss the details of your case more fully. Hopefully, that way, you’ll be able to rest easy knowing that your case is in good hands.