What to Do If Your Health Insurance Claim Is Denied

You may often need to rely on your health insurance to limit the financial burden of maintaining your well-being or recovering from injuries and illnesses. However, there may also be times when you think something will be covered, but you receive notice that your claim was denied. In these situations, knowing how to proceed can be crucial.

Five Steps After a Claim Denial

Receiving a denial for a health insurance claim can be frustrating and stressful. Fortunately, there are several actions you can take to address the situation and potentially reverse the decision. Consider the following steps:

1. Understand the reasoning. Thoroughly review the denial letter from your insurance company, as it should provide specific reasons for the denial. Common explanations may include lack of coverage for a specific service, a lack of information, or the treatment being deemed medically unnecessary.
2. Gather information. Collect all relevant documents, including medical records, doctor’s notes and any correspondence with your insurance company. These materials will be essential if you decide to appeal your carrier’s decision.
3. Contact your insurer. Reach out to your insurance company and request a detailed explanation of the denial. In some cases, a simple clerical error or missing information can be resolved quickly and save you both time and stress.
4. File your appeal. If the carrier’s denial stands, you have the right to appeal. Follow the instructions provided in the denial letter for submitting an appeal. Be sure to include all supporting documentation and a letter from your health care provider explaining why you needed the treatment in question.
5. Enlist outside assistance. If your appeal is denied, you can request an external review by an independent third party. This process may require working with a state insurance department or federal agency. You may also want to seek out the services of a patient advocate or health care attorney.

We’re Here to Help

Contact Ashley Taylor Insurance today to learn more about the health insurance claims process and how you might be able to navigate various hurdles and complications.

This blog is intended for informational and educational use only. It is not exhaustive and should not be construed as legal advice. Please contact your insurance professional for further information.