Health insurance has a lot of advantages and one of those is to help us avoid large out-of-pocket expenses. When a claim is denied it can be very disappointing, but here are some tips to help you take the next steps:

  • Revisit your policy; gather questions, and contact your insurer and your medical provider.
  • Ask the provider for medical records and billing details, including codes. Ask carriers why your claim was denied.
  • Appeal the denial. Insurers usually provide information on their appeals process in print and online.
  • Act quickly; there are often deadlines for appeals. Submit a letter explaining what the procedures were billed for and why your claim should have been paid. Include medical records and X-rays or lab work.
  • If your appeal is denied, you have two choices: Accept the result or try again. Carriers usually allow second-level appeals with 60-day deadlines.
  • You also can attempt to resolve the issue through arbitration. The insurer or policyholder can begin the process by notifying the other in writing. Before doing so, contact your state’s insurance regulator for information on health insurance claims laws.
  • Finally, you could contact a lawyer, but be aware that this is an expensive route to go.

It is always a best practice to ask the questions before a procedure or appointment to avoid denied claims in future. For help with you health insurance or to inquire about getting help with a denied claim, contact Brazelton Insurance Group.