How to File an Appeal With Health Insurance
It's disheartening when your health insurance company rejects one of your claims. Usually, you find out about the rejected claim through the mail or when you check the status of the claim online. An insurance company doesn't always perceive a complaint to customer service over the phone as a formal appeal, so follow the appropriate steps to register a formal appeal with your insurance company.
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Instructions
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1
Go to your insurance company's website, and find out the process for filing an appeal with the company. You can also ask the customer service department over the phone about how to file an appeal.
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2
Write and send a formal appeal to your insurance company. Include details about your health problems, your doctor's prescriptions and treatments and reasons why you need the insurance company to honor the claim. Also, include any medical records or documents that support your appeal. Give an emotional touch to your appeal about why you need the coverage.
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3
Appeal directly to the president or company head if your health insurance company is local or regional. Find the appropriate email addresses online at the company's website. Send an email to air your grievances.
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4
File an appeal with your state's insurance commissioner. Send a copy to the head of your insurance company. You can also send a copy to your local Better Business Bureau.
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5
Inform your health insurance company that you'll contact the media. This may prompt the company to address your problem instantly.
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Tips & Warnings
Before filing an appeal with your health insurance company, read the terms and conditions of your policy. Research things like your coverage amounts, exclusions, conditions concerning cashless schemes of using services from network hospitals and requirements for authorization before a hospital stay or surgery.
This process can drag on, and you may spend hours on the phone. Try to resolve the issue by getting in touch with the appropriate point of contact at your health insurance company. However, if the company's negligent or playing ignorant, exercise Steps 3 and 4 to take stern action against the company.
