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What To Do When Your Health Insurance Won’t Pay

To sum it up...
  • 10 percent of claims are wrongfully denied
  • You have multiple options to appeal these denials
  • Most people who appeal claim denials see a positive outcome

Many people have been in a situation where a claim is denied by their health insurance. This may be very scary, but you do have options to deal with this eventuality.

Of course, you should look into the reviews of different health insurance companies when you are reviewing quotes online. This will help you get an idea of how often health insurers deny claims.

You should pick a health insurer that does not have a reputation for denying legitimate claims. Sometimes, through a misunderstanding, your health insurer will deny your claim. If you find yourself in this situation and you need to figure out how to get your claim accepted, read on.

This article will provide you with several different strategies that will greatly increase your chances of getting your claim accepted. This can save you thousands of dollars and ensure continued coverage in the future.

Your options when your insurer won’t pay a claim aren’t necessarily limited to those in this article, but these have been proven to be effective.

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Don’t Accept it When the Insurer Says No

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Roughly 10 percent of all insurance claims are wrongly denied. However, fewer than 1 percent of people question these decisions. The majority of people who do question denials either get their claims fully covered, or at least partially covered.Don’t panic if your health insurance company turns down your claim. Instead, let them know immediately that you plan to question their decision.

Don’t panic if your health insurance company turns down your claim. Instead, let them know immediately that you plan to question their decision.

Demand a Written Explanation From Your Insurer When They Deny a Claim

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Most states require an insurer to issue a written explanation detailing the reasons for denying a claim. You should look on the internet to see if your state requires a written explanation.

Even if it does not, you can still request a written explanation. Having a written explanation that details your insurance reason for the decline and they claim will help you fight this decision.

If you live in a state where an insurer is required to provide you with a written explanation of why they denied your claim and they do not, this may actually be against the law.

If you do live in one of those states, you should look into your legal recourse if the insurer does not provide you with a written explanation. Different states handle these cases differently.

Check Your Policy Painstakingly To Make Sure the Denial is Legitimate

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Often times health insurers will decline claims even though they should be covered by the terms of the policy. These declines are usually simple misunderstandings. However, there had been some unscrupulous health insurers who have intentionally declined legitimate claims in order to get out of paying them.

The first thing you should do to avoid this is to do your research when comparing health insurance quotes online. This will help you avoid unscrupulous healthcare companies. If you still have a claim denied, check your policy very carefully to see if the claim should have been approved.

This can be a very boring and tedious process, as you will likely have to read multiple pages of small print. However, if you can find a legitimate justification in your policy for the claim being covered and you present this to your insurer, it is almost a sure thing that your claim will be covered.

The first thing you should do to avoid this is to do your research when comparing health insurance quotes online.

If you still have a claim denied, check your policy very carefully to see if the claim should have been approved. If you can find a legitimate justification in your policy for the claim being covered and you present this to your insurer, it is almost a sure thing that your claim will be covered.

This can be a very boring and tedious process, as you will likely have to read multiple pages of small print. However, if you can find a legitimate justification in your policy for the claim being covered and you present this to your insurer, it is almost a sure thing that your claim will be covered.

Mistakes in the Paperwork are Not Legitimate Reasons to Refuse a Claim

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There is a lot of paperwork required to file a health insurance claim. This paperwork is usually handled by a designated medical billing professional employed by the health care provider’s office.

While these professionals are usually highly accurate, they do sometimes make mistakes. In the past, insurers have used such mistakes as reasons for denying a claim. As long as the claim is corrected, this is not a legitimate reason.

Don’t let your insurer deny a claim for a typo or similar mistake. Contact them and let them know that you are aware of the law.

Do Research to Support Your Appeal

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If you do receive a payout from your health insurance company that is less than you were looking for, don’t simply accept it.

Call other doctors in the same area and check to see what they charge for the same service. If it is significantly more than what the insurance company has offered you, use this information as leverage to demand more compensation.

Don’t Give Up

Most people who appeal a denied claim receive at least a partial payout. If things don’t seem to be going your way, try something else. Remember that you are responsible for being your own advocate.

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