Navigating the insurance world can be tricky, especially when you're faced with a denial of coverage for your medical treatment. While a denied claim can be frustrating, it's essential to review the denial carefully as it usually explains the steps to take to make an appeal.
Let's first understand why a health insurance company may not approve a request or deny payment. Here are some common reasons:
If your healthcare treatment is denied by your insurance carrier, you have two main options:
Internal Appeal Nearly all insurance companies have an appeal process that allows you to challenge their decision. This is known as an internal appeal. To start this process, you will need to review the denial letter and follow the instructions on how to appeal. You will be required to provide additional information and documentation to support your claim before the insurance company will make a decision.
External Review If your internal appeal is denied, you have the option to request an external review. This is done by a third-party organization that is not affiliated with your insurance company. If the organization takes on your appeal, the process shifts the final say away from the insurance company to the independent organization. External reviews are available in most states.
If you're not sure where to start or need more help, here are some resources to consider:
Before beginning any appeals process, it's essential to review your denial carefully, understand the reasons for the denial, and explore your options for appealing. While the process can be time-consuming and stressful, it's worth fighting for your health and your rights as an insured individual.