How To Fight A Denied Insurance Claim

Health insurance claims can be denied for any number of reasons, from noncovered charges due to the nature of your injury, to using the wrong provider, to silly mistakes such as errors on the claim such as a misspelled name. The bill could have even gotten lost in the mail and sent to the wrong employer!

Also Read: How Mediclaim Differs From a Health Insurance Policy?

Regardless of the reason why the claim was denied, here are some ways to fight to get it approved again and get the coverage you deserve.

Have an understanding:

If you understand why the claim was denied, you stand a better chance of fixing the problem. Using an explanation of benefits (OEB) to understand the form sent by the insurance company, you can figure out exactly what the problem is and how to fix it.

An EOB is basically a snapshot of how a medical bill was paid, and it includes the charges, the amount that was billed, charged, and not covered by the insurance company. Then below that, the reason code states why a service wasn’t covered. Looking at and understanding the reasons why your insurance claim was denied is the first step.

Gather evidence and paperwork:

Gather your medical history, any prescriptions from a doctor, referrals, and the claim number along with any other paperwork and keep it all in one place. This will show that your claim is necessary and viable and will also give the insurance company all the information it needs to review your proposal.

An organization is a key here, as even the smallest details such as a misspelled name or typo can cause large problems. Taking notes, especially with the various people you will be calling during this process, as well as asking for document image numbers will keep both you and the insurance company on the same page.

Finally, following up with the company and having a schedule and set time to make the calls will also help keep the process moving forward, while also sending a message that you would like an answer, which should help the claim move a little faster.

Getting Legal Help:

Legal action can also be a valuable tool if you can’t get an answer on your own. Many personal injury lawyers, such as a good slip and fall lawyer, are able to help with personal injury cases where insurance claims were denied, such as work-related injuries, vehicle accidents, and even tumbles on slick surfaces.

Contacting a good and reputable lawyer is the first step, only if you haven’t made any headway on your own or the company has denied your claim. By finding a lawyer willing to represent you, you can ensure that all your legal options are explored and you have the best chance at getting your claim denial overturned and the insurance-related help you need.

An insurance denial is not the end of the world and can be fought with various strategies to be overturned, so don’t lose hope and know that you will get the coverage you need.