Tips for When Your Insurance Denies a Claim

If your insurer won’t pay for a healthcare service, or pays less than you had
expected, you have the right to “appeal,” or ask for your case to be formally
reconsidered.

Before you file an appeal, talk to your insurer and find out why the payment was denied. It
might have been a simple mistake, like a coding error. But the payment may have been
denied for some other reason—for instance, because your insurer did not find the treatment
medically necessary. In that case, you can ask them to reconsider their decision, also known
as an appeal.

There are several ways to get instructions on the appeals process. You can call your plan,
visit your insurer’s website or read your plan documents or Explanation of Benefits (EOB).

To learn more about what to do when you disagree with an insurance decision,
read this article from FAIRHealth.