How to Fight a Health Insurance Claim Denial and Win

The aftermath of a health issue can be a tough time. Not only do you have to pay medical bills, talk to your insurance, and get back on track after your recovery, but you also have to do all of these things while dealing with the negative effects of your injury or illness!

That’s why it’s so important that you have a health insurance company that supports you during the process. If, on the other hand, you experience a health insurance claim denial, then you have every right to fight it with an internal or external appeal.

In this article, we’ll teach you how to fight a health insurance claim denial so that you get the restitution that you deserve. You must also know how to pick the best health insurance plan for senior citizens?

Internal Appeal

When you see the troubling words “insurance claim denied” on the letter you receive from your insurance company, you have three options before you. One, you can eat the cost of the medical bill yourself.

Two, you can file an external appeal with an independent third-party. Three, you can file an internal appeal.

The internal appeal should be your first action item when you get a health insurance claim denied. The internal appeal is routed to the insurance’s own appeals team, wherein they take a look at whether or not the adjudicator for the particular claim was wrong in denying your insurance.

Related: 9 Ways to Violate HIPAA (Without Even Realizing It)

There are a few things to note when you file an internal appeal.

Firstly, be sure to include as much documentation as you can. The more evidence you have about why the medical bill should be covered, the better.

In addition, you should try to cross-reference the relevant parts of your policy that support the acceptance of your claim. To do this, you’re going to have to pull out the legalese and the policy documentation.

External Appeal

If the internal appeal doesn’t work, then it’s time to consider an external appeal. whether you were injured in a hotel, a car accident, or at work, you always have the option to file an external appeal with an independent third-party whenever you have a claim denied.

The first thing to note about this process is that the third party is going to have the authority to deny your claim or force the health insurance company to approve it. In the event that it does the latter and the insurance company still doesn’t pay, then it’s going to be time to take the case to court.

At every step, you should weigh whether or not fighting the claim denial is worth it, given the legal costs and fees you may have to assume.

How to Fight Health Insurance Claim Denial

There you have it. Now that you know how to fight your health insurance claim denial, all that’s left is for you to start the process with an internal appeal today. Be sure to follow up with an external appeal if the internal one doesn’t work and the financials of the claim justify the legal expense.

For more general advice, check out the rest of the website!