Health insurance is one of the most complicated, tedious areas of insurance to understand and navigate. Moreover, a health insurance claim denial can threaten your financial security and effect your ability to access medical care. The first thing to do is to identify the insurer’s reason for denying your claim. The insurer, your doctor, or the hospital may be able to help explain the insurer’s stated reasons for refusing coverage. The reasoning behind a denial will provide some insight as to your options.
Many of these reasons for denial can be addressed, either by appealing the insurer’s decision, or by contacting the doctor or hospital to make corrections to the documents submitted. When an insurer refuses to pay a claim, you may respond or appeal in the form of a letter that includes your best arguments against the decision and any supporting evidence or documentation. This appeal should focus on the specific grounds for denial that were listed in the notice of denial provided to you by the insurer. Where an appeal is unsuccessful and the insurer refuses to accept your valid claim you may need to sue them for their claim denial.
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