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  4.  » What do I do if my submitted insurance claim was denied?

What do I do if my submitted insurance claim was denied?

On Behalf of | Dec 13, 2022 | delayed and denied insurance claims | 0 comments

If you have submitted a medical insurance claim and it was denied, you will want to appeal the denial. The process of the insurance company is that they will review your coverage for medication, service or treatment, either prior to or after you file your claim.

If your insurance company denies your claim, you have every right to appeal the denial through the internal appeal process of your insurance plan.

The appeal process is a step-by-step process with the following steps:

  1. Review your plan: The first thing that you will want to do is read your insurance plan very carefully. The appeal process should be outlined in there but if you can’t find that information, you will want to reach out to your health plan or your employer to obtain appeal process details. It is pretty typical that you may be asked to fill out forms or submit correspondence in the form of a letter that appeals the insurance company’s denial decision.
  2. Submit your appeal to the insurance company: Filing your appeal is most likely going to be time-sensitive. Commonly, you may have 180 days (six months) of when you received notice of the denial to appeal the decision. You can also include any other relevant information with the appeal that you think may help the insurance make the decision in your favor. Although you don’t have to include many details, you should state in the appeal which denial you are appealing and the justification of why the insurance should grant your request.
  3. Make sure that you have copies of all of your paperwork: You will want to keep copies of everything that you submitted to the insurance, including your Explanation of Benefits (EOB) forms, copies of all of the paperwork that you submitted to your insurance company and any notes of discussions that you had with your health plan representative regarding the appeal.
  4. Ask for an independent review: If your appeal still didn’t work, you can request an independent review organization (IRO) to review your case. Your insurance company is responsible for conducting an independent review. The insurance company must pay for the independent review and must comply with the decision that was made by the individuals who conducted that independent review.

Support from a Texas insurance dispute attorney

When you file a claim with your insurance company, you need the money and you deserve the money as well. However, it is easy to become frustrated because your insurance company is pushing back unfairly and not giving you what you are entitled to receive. This is where an experienced Texas insurance dispute attorney can really make a difference to your case and to the outcome of your case. The attorney can help you through the process and can hopefully positively affect the outcome of your case.