Steps to Appeal a Health Insurance Claim Denial

No, chances are your health insurance does not cover every possible service you receive.

You likely have a deductible and co-pays, services must be medically necessary – despite what your doctor may say – medical necessity is not precise, there are many factors involved.

Errors occur, sometimes the way your provider codes and submits a claim, sometimes by the insurer. Sometimes a service is just not covered, sometimes services are out of network.

Nevertheless the great bulk of claims are paid without a hitch.

Here are tips on how to deal with insurance. Make sure you give all the facts and circumstances when appealing a denial.

When you’re recovering from an illness or injury, having a health insurance claim denied can be frustrating and stressful. Take a deep breath, then read this step-by-step guide on how to appeal a health insurance claim denial.

Step 1: Find Out Why Your Claim Was Denied

Before you can submit an appeal, you need to understand why your claim was denied. Review the denial letter from your insurance plan to find out more. Your claim may be denied if:

• There was an error when the claim was filed, such as missing or incomplete information in the claim documents
• Your plan does not cover the service you’re claiming
• The service was deemed not medically necessary
• Your plan doesn’t cover the out-of-network provider
• You have reached the coverage maximum of your plan

The claim denial notice should include detailed information about the denied claim, how long you have to appeal the decision, and how you can appeal the decision.

Read the following steps at this link