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How to appeal a health care insurance denial

On Behalf of | Mar 8, 2023 | Delayed And Denied Insurance Claims | 0 comments

When health insurance works as it should, you don’t have to spend much time thinking about it. You show your insurance card, see your doctor, pay any necessary copay, and go on your way.

But when health insurance doesn’t work as it should, it can be a nightmare.

One common scenario involves getting a letter in the mail, weeks or even months after your doctor’s appointment, telling you that your claim has been denied. Sometimes, they don’t tell you why.

Often, these letters are written in dense, hard-to-understand language. Somewhere in the text, you should see a mention of an appeals process. What does that mean?

The appeals system

That mention of an appeals process may be misleading. It doesn’t necessarily mean going to court and arguing fine points of law. Most of the time, all it means is that you have an opportunity to contact the insurer and contest the denial. This is known as an internal appeal.

For example, say you went to your usual doctor’s office and the doctor said you should have a blood test to help determine if there’s something wrong. You had your blood drawn and the doctor’s office sent it to the lab for analysis. Weeks later, the insurance company sends you a letter saying it is denying the insurance claim for the blood test.

Most of the time, the reason for this is simple: The insurance company wasn’t expecting the blood test and so it wants more information. Instead of calling your doctor’s office to sort things out, it contacts you.

Intimidation tactics

Many people are intimidated by these letters and have trouble understanding their complex language. They may not have the time to spend on the phone with the insurance company to clear up the issue, and so they may be tempted to simply pay the bill and get it over with. Needless to say, the insurer likes that result because it saves the company money.

But, if you take the time to push back, it may be easier than you think to get an insurance company to reconsider.

Unfortunately, that isn’t always the case. In some cases, you will have to push back harder. You may need a skilled negotiator, and you may even need to go to court. Attorneys help people push back against denied health insurance claims.