What to Do When Your Health Insurance Claim Has Been Denied

"It's unsettling to receive a letter from your insurance company telling you that your request for medical care, or for payment of care you've already received, has been denied," says Ann Carrns of The New York Times. If this has happened to you, then you know what she's talking about. Maybe you've thought, "Just what I need, another complication to deal with." Well, you're not alone, and maybe there is something you can do about it.

In her recent article, "7 Steps in Appealing a Health Insurance Denial," Carrns includes things you can do to increase your chances of filing an effective health insurance appeal. She cites advice from friend and trusted partner of HealthyWomen, Martin Rosen, co-founder of Health Advocate, a company that helps people to navigate the confusing ins and outs of health insurance claims.

Among Rosen's key tips are (as written in The New York Times):


  • Check the details of your insurer's appeals process. In the coverage documents and summary of benefits, insurance companies are required to give all the tools needed to properly make an appeal. There are often deadlines to meet, so act quickly.
  • Have your paperwork in order. Keep records of everything: the bills from your provider, your explanation of benefits, copies of denial letters, medical records, letters from your provider of care, etc.
  • Call your human resources department if you receive coverage through your employer. The department may provide direction, advocate on your behalf and help to translate the fine print of the policy.
  • Enlist the help of your doctor. Check the medical policy and ask your doctor to review it to prepare something called a letter of medical necessity to support your case.

For the rest of Rosen's tips and to read the full article, click here.

For more on Health Advocate and its consumer services, click here.

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