4 Tips for Dealing with a Health Insurance Claim Denial

It seems like living in an unhealthy way is more affordable than leading a healthy life nowadays. Unhealthy foods, carbonated drinks, junk food, and snacks seem cheaper than the healthier options. 

In case you face a health emergency or need to go for a regular checkup, you also need to have insurance. Otherwise, you may prefer not to go at all. It doesn’t end there.

Insurance companies thrive by not giving out money to everyone who asks for it. Therefore, they mainly try to reject applications. In that case, you might find yourself stressed out and troubled. So, what do you do about disputing insurance claims? Let’s see.

Understanding the Types of Health Insurance Claims

Any insurance policy is a contract between an insurer and a policyholder. The policyholder agrees to a premium, and the insurer promises to compensate for certain medical expenses. 

You should look into the different types of health insurance policies and how they work before selecting one for yourself. If you already have one, read the fine print on your policy. 

Your insurer will give you a reason for rejecting your application. You can read your insurance policy to confirm it. If you’re having trouble, contact a lawyer to figure out the details. 

Talk to the Insurance Company or Your Provider’s Office

The decision between the two largely depends on the problem at hand. If your policy says the services you received should be covered, get in touch with your health care provider’s office.

Tell them that your policy shows the services are covered, but your claim was denied. Ask them to confirm whether they correctly submitted the claim with the insurer or not. Sometimes there are coding errors, and they can be quickly resolved. 

Start an Internal Appeal Process

If your provider’s billing office wasn’t any help and your insurance company isn’t either, file an internal appeal.

Here, you will need to send a letter that should show why the service you are claiming for should be covered. Alternatively, you can fill out a form the health insurer should provide. A good example would be saying that an out-of-network health care provider was the only one in the area who was offering the service. 

You have 180 days from the denial date, and the insurance company should decide within 30 days. However, you can expedite the process for emergencies.

Go the External Review Route

Getting another rejection from the insurance company wouldn’t be surprising. They try their best not to pay. But you still have another choice. You can get an independent or external review.

The independent reviewer depends on your insurance provider and your state. Some insurance companies have to deal with independent review companies to handle the cases. If they don’t, then it depends on your state. Some states have an external review process, while others let the federal government take care of these disputes. 

If you don’t already have a lawyer, it may be useful to get one. Otherwise, you can contact your state’s insurance commissioner’s office for some guidance. 

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