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Appealing An Insurance Denial

Feb 7, 2008
If you've gotten a denial from your insurance company regarding a claim, you're certainly not the only one. Getting your claims paid by your insurance company can feel like a scene from David and Goliath. You may feel all alone as you try to get the "big, mean insurance company" to cover your claim. Learning all that you can about how insurance companies will serve you well in the long run.

Go over your policy inside and out. Review it regularly to be certain that you know exactly what is covered and what is not. If you have any questions, contact your insurance company and request they explain the policy to you clearly. Be certain you understand all exclusions and limitations. Also, go over the section that explains how to appeal a claim.

When you receive medical care, make certain your provider is aware of what is covered and what isn't. Also, doctors deal with a great deal of patients and they won't remember the details of each patient perfectly. Remind them if they want go ahead with a procedure that you know your carrier will not cover.

Follow your policy provisions closely. If your policy requires that you get prior authorization for a procedure or before going to a specialist, be sure that you follow those guidelines. Do not make assumptions. Always check first.

If you are denied coverage, review all the paperwork carefully. Organize everything so it is easy to access and makes sense to you. Then, call the insurance company's customer service number. Ask the representative about the denial you recently received and notate all the details of the conversation.

Often, denials of coverage are due to some administrative error. It can usually be resolved after the first phone call. If the denial continues and is not due to error, then request an itemized bill from your provider and go over every charge. If there is a charge for services not delivered, call the provider immediately and have the bill adjusted.

If the denial is legitimate and due to a procedure they deem unnecessary or experimental, then request a formal review of your claim. You can get the specifics from the customer service representative. Then send a certified letter stating your case in writing and request a return receipt. Do this right away because many insurers often have time limits on appeals.

If, in the end, you feel you've gone over all possibilities contact your state's department of insurance for help. Every state has a department to help consumers with disputes with insurance companies.
About the Author
Getting your insurance to cover your claim can be a stressful process. It's good to know as much regarding insurance as possible. Do as much information as possible. For additional information regarding insurance, go to href="http://www.webhealthcoveragenic.com/">http://www.webhealthcoveragenic.com/
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