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This Is How You Can Appeal A Rejected Health Insurance Claim

When your health insurance company denies pre-approval for the care that you need or rejects a health insurance claim, it’s normal to lose heart. However, this is not the end of the road for you. As a matter of fact, there is a lot that you can do by attempting to reverse the decision. Do know that each and every health insurance policy have a process through which you can make an appeal. However, that can prove to be quite challenging for you, especially if you have no medical background. Such a situation can be pretty overwhelming for you. Moreover, you have to give extra effort and time for this. So what are the steps through which you can appeal? Read on to know.

Go through Your Policy and Paperwork

Review the summary of the benefits in the insurance documents. Each and every detail regarding your coverage must be available in the paperwork. Aside from that, you will also come across the exclusions or limitations. Also, review the letter or form which you had received after you availed a particular insurance plan. You will hopefully get to know why there was a claim rejection. The letter must also intimate you about how to appeal against the decision and from where would you get the help to set the ball rolling.

Know Whom You Can Call for Your Queries

A few rejections are comparatively easier to solve than others. In a situation where your insurance company has rejected your claim, it’s mandatory for you to know whom to call for help. If you have no idea why your claim faced rejection or have other queries regarding your insurance policy in your mind, call your insurance company. That’s the best thing to do. Ensure that you find out whether the rejection was just because some information was missing or there were some errors in the billing.

If you have made up your mind to appeal against the rejection, you can ask your representative to go through the process with you. You can also ask him to mail you full details of how to male an appeal. Another option is to ring up the doctor’s office if you come to know of the insurance claim rejection. Ask the staff there to look up for the errors, fix them up, and send the requisite paperwork to the insurance company one more time. In case you are receiving coverage from your employer, contact the HR department for details.

Learn How to Appeal

If your insurance company rejects an insurance claim, you have every right to file an appeal. The law states that you can appeal with your insurance company and ask an independent third party to carry out an external review. Keep in mind that you have to abide by the appeal process of your insurance plan. Call the customer service or go through the website which gives you the details of your plan.

Following detailed instructions regarding how to appeal is necessary. Also, be sure if there is a deadline within which you have to file an appeal. Intimate your doctor or hospital before you file an appeal. You should also inform your attorney about the denial and the steps you are going to take next. This way, you can gather lots of additional and relevant information from your attorney which would come handy later.

File Your Complaint

Contact your doctor if your insurance company rejects your claim for a treatment you have already gone through or a treatment that your physician wants you to go through. Ask your doctor to forward a letter to the insurance company that talks about why you went through a particular treatment.

Find out the address given in the appeal process and make sure that your letter reaches the right place. A copy of the letter can be kept side for future reference. In case the outcome of your appeal is not convincing, you can request for an external appeal. Remember, you can always ask a third party, which is in no way related to the insurance company or you, to review all the details from the start. Generally, you will have not more than four months from the date on which you made an internal appeal to file an external appeal.

You need to keep yourself informed about what’s covered by the insurance plan you have availed and follow the rules stated in your health plan. Aside from that, find out if there are any limits on the benefits that are offered along with the plan and also get to know whether your insurance provider falls within your plan’s network.

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