How to Appeal a Denied Insurance Claim

Do not be surprised and disappointed if your insurance claim has been denied or rejected. Review the rejection reasons carefully and file for an appeal. It is another way of helping yourself to become aware of the facts and reality of insurance policies. This will also make you prepare for challenging the future denials by your insurance companies. For example, it is possible that your insurance company disputes the claim you have filed for medical expense. But once you are prepared beforehand and know the process more thoroughly, you can successfully lodge an appeal and get it accepted.

Do not accept an insurance denial and sit idle. You must challenge your company over rejection reasons and fight them through an appeal process, which is your basic right. Some consumers tend to accept the denial at its face value for many reasons. The most common among those reasons is that they do not want to get tangled into the appeal process, even they may know that the chances of winning the appeal are greater. This tendency encourages insurance companies to give even tougher time to consumers to get medical cover timely, and a negative impression on other consumers. So learn to fight for your due claim.

Instructions

  • 1

    Know Your Insurance Policy Details

    You should be aware of all details that your insurance policy states. This includes the amount of coverage at one time and throughout the year, how you can claim the cover and other procedures. Without knowing these details you will not be able to file an appeal effectively.

  • 2

    Get Information From Company

    If you are having difficulties in knowing the procedure and requirements of filing an appeal and are not satisfied with the explanation given in your policy, you can call your insurance company directly and ask them about details around filing an appeal to the denied claim. They should be able to help you out with requirements and procedures of filing an appeal.

  • 3

    Get Help From HR

    If your medical insurance cover is through your employer, you can get help from your HR department on how you can appeal against denial of a claim. They might be able to file an appeal on your behalf, talk to the insurance company about the issue or at least give you details of all requirements and procedures.

  • 4

    Fill Out Appeal Form

    Once you have gathered enough information and know the process of filing an appeal, you download an appeal form or get it posted to your address. You fill it out carefully and fulfil all requirements before sending it.

  • 5

    Write Letter, Include Other Documents

    You can also explain all situation, and other details, which an appeal form may not cover and attach it with other required documents with the form before either posting it or submitting directly online. In case of submitting the form online, you will still be required to post all required documents.

  • 6

    Get Your Doctor's Help

    You can also get help from your doctor in form of a letter or any recommendation. This will strengthen your appeal. Sometimes you can get help from an advocacy group, which you should do if think your company is unnecessarily causing hurdles in the way of your insurance claim.

  • 7

    Wait For Response

    After you file an appeal, wait for the response from your insurance company. Follow all the process closely and may also keep asking for latest status of your appeal.

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