How To Appeal A Rejected Health Insurance Claim

How To Appeal A Rejected Health Insurance Claim

Has there ever been a time when you went for a medical procedure and later find out that your insurance won’t pay for it? It happens more times than you think.

how to appeal an insurance claim denial

While you may be extremely frustrated and upset it doesn’t mean you should panic. You do have appeal options that can potentially reverse the decision.

So what should you do once you get that rejection letter in the mail? Here are some tips and options:

  • Look over your insurance benefit documentation. This document should specifically spell out what is covered and what isn’t. In addition, read over the rejection letter and the specific reason why the claim was denied for payment.
  • If you still don’t understand why the claim was denied, call your insurance company. Sometimes a claim may be denied due to missed information from a physician or a billing error. It is here that you can ask about the appeals process and how to start one.
  • If you do file an appeal, let your hospital and/or doctor know and see if they can wait on sending bills until you hear back from the insurance company. You don’t want to end up have your statement turned over to a collection’s agency.

Once you file an appeal, which you are guaranteed by law, your claim will get a second look internally by others that were not involved with the initial denial. You can also ask for the appeal to be expedited should it be a medical emergency.

Should you not be happy with the internal appeal you have the opportunity for an external, third-party appeal, or someone outside of the insurance company review your case. You will have a limited amount of time to proceed with the external review so don’t wait too long to start that process should you go that route.

Remember, always keep good notes and records of who you spoke to and when, during every phone call. That way you have paper backup as many times the calls you have with them are recorded for quality purposes and can be traced.

Should you have questions on denied claims or the appeals process for your specific insurer contact us at Florida Healthcare Insurance. We will be happy to assist.

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