Over 200 million health insurance claims are denied every year, but there’s hope! Reports show that you have a 50/50 chance of successfully appealing your denied claim. Follow these 5 steps to increase your chances of getting the coverage you need.

For appealing a denied health insurance claim, specifically:

1) Find out why your claim was denied. The three main reasons your health insurance claim may be denied include administrative errors, out of your network treatments, or because your insurer considers your treatment “medically unnecessary”.

2) Build your case. Once you understand why your health insurance claim was denied, collect whatever evidence is necessary to build your case. This could be medical records, policy guidelines, or even scientific research supporting the necessity of your treatment.

3) Submit a letter of medical necessity. If your treatment was considered unnecessary, your doctor can submit a letter of medical necessity with your appeal. Make sure to ask for your insurance company’s “clinical policy guidelines” first. Your doctor can use these to tailor his or her letter so that your treatment clearly meets your insurance company’s guidelines for what is considered medically necessary treatment.

4) Seek help for navigating the claims process. Your hospital should have social workers that can help ensure you receive all the benefits you are entitled to. You can also seek help from a qualified lawyer or nonprofit patient advocate organization.

5) Appeal your denial (multiple times, if necessary!) Medical insurance companies use extensive databases and specific formulas to help keep track of denied and appealed claims. If you appeal your denied coverage multiple times, you increase your chances of receiving the approval and coverage you need.

Whether you are appealing a denied health insurance claim or any other kind of denied insurance coverage, make sure you also follow these 3 additional helpful tips:

1) Research your insurance company’s appeals process. Every insurance company should have its own process and timeline for submitting an appeal. Don’t risk your claim being denied again just because you missed your company’s appeal deadline.

2) Keep detailed records of your correspondences. Whether you are communicating with your insurance company, doctor, lawyer, or social worker, make sure you keep detailed records of your correspondences.

3) Follow up on your appeal. Once your appeal has been submitted, you should regularly follow up with your insurance company to ensure that they received the necessary documentation and are moving forward in the appeals process. You can also request a status report on your appeal, which is especially important as you near the deadline for appealing a denied claim.

If your health insurance claim is denied, contact one our claim advisors at ClaimCounsel to see if we can help get the benefits you deserve.

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