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How to appeal a health insurance claim denial

On Behalf of | Jan 3, 2020 | Workers' Compensation

When an individual files a health insurance claim in Arizona, the insurance company views this as a liability. The more money that insurance companies pay out to the customers that rely on them for coverage, the less they have left for profits. To reduce expenses, many insurance companies find any reason possible to deny a claim. This keeps money in their pockets while putting people in desperate situations at serious risk. 

According to Forbes, the first step to follow after a health insurance claim denial is to remain calm. There are several available options to reverse the company’s decision. There is no guarantee these will work, but trying may be better than doing nothing at all. Doing nothing could cost a person their home, savings and good credit. In some cases, it can cost a life. 

The next step is to make a plan to act immediately. Too many people wait until years later when collectors are now calling about the medical bills to try to go back to the health insurance company. This may be too late. 

The good news is that sometimes a resolution is a simple phone call away. A denial may occur because of an error. There may be missing files, a glitch in the system or an error in the medical codes used for billing. Clearing this up easily resolves the issue in these cases. 

If there is no error, then individuals may need to plan a more official appeal. WebMD recommends the following: 

  • Review the insurance policy and any accompanying paperwork. 
  • Keep all medical records and organize them. 
  • Follow up with all relevant parties and gather more information. 
  • Learn about the appeals process. 
  • File an appeal. 

The appeals process is intimidating. For this reason, many people work with professionals to improve the likelihood of success and reduce the stress associated with the process.