How to Dispute an Insurance Claim Denial

You can--and should--appeal a claim denial.

It is important for everyone to have insurance coverage in place, and you hope that every claim you file will be paid on time and in full. However, there are times when the insurance company will deny your claim, and when that happens you need to use the proper procedures to appeal, and hopefully reverse, that denial. Dealing with an insurance company is rarely an easy process, but with the right tools and the right information you can ultimately prevail.

Things You'll Need

• Insurance policy
• Claim denial
• Medical bills

Instructions

1. Read the claim rejection thoroughly and make sure you understand the reason for the denial. Call the customer service number listed on the claim denial for clarification if necessary.

2. Take detailed notes of any conversations with insurance company representatives. Ask the name of the representative at the beginning of the call and note the time and date of each conversation.

3. Contact the doctor or hospital that originated the claim and request an itemized bill. As a health care consumer, you have a right to see an itemized list of charges resulting from a hospital stay or doctor visit.

4. Call the customer service number for your insurance company and let the representative know you wish to file a formal appeal of the claim denial. Take detailed notes of the conversation, and note which forms are needed to file the appeal.

5. Ask the representative if the appeal forms are available online. Many insurance companies make these forms available on their websites. If the forms are not available online, ask the representative to mail the form to you. Keep notes of your conversation so you can follow up later.

6. Complete the appeal form to get the appeal process started. Refer to the itemized bill from the doctor or hospital when filling out the form. Attach copies of your documentation to the appeal form, and be sure to make copies of the form and supporting paperwork for yourself before mailing the form.

7. Follow up with a call to the insurance company if you do not receive an acknowledgement of your appeal within five to seven business days. Take notes when you call, recording the name of the representative and the time and date you called.

Tips & Warnings

• Consider hiring an attorney if the claim is a large one. For smaller claims the cost of a lawyer could exceed the value of the claim.

References

• Bankrate.com: Fighting Your Health Insurance Company