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My health insurer denied my claim. What’s next?

Time and time again health insurance companies deny legitimate claims and leave patients without the care they need. Whether you run into issues with prior authorization or out-of-network disputes, a denial does not mean the end of the road. Patients can fight for their rights and advocate for the medical treatment they require.

Here are three ways that patients can stand up for their rights and overturn a denial from their health insurance company.

Request an explanation from the insurance company

Before you can fight the denial, you’ll need to know why the claim was denied in the first place. Some insurance companies have a reputation for routinely issuing denials, but sometimes they aren’t legitimate. You can contact your insurance company’s customer service to get an explanation of the denial letter.

Write a letter to the doctor

Your physician can write a letter explaining the medical necessity of the procedure or treatment being requested. The letter will explain your medical history and help you to contest the decision. If they still deny your claim, you have the right to file an appeal.

Consider requesting an appeal

If your insurance company refuses to budge, you can request both an internal or external appeal. You can request an external review if your claim is still denied after an internal review. You will want to contact the insurance company directly as they each have different processes for requesting an appeal. The company will then conduct a full review of the denial after the internal appeal. For formal appeals, an independent third-party can override an insurance company’s decision and issue their own approval or denial.

There are a number of resources at your disposal to help you navigate the claims process and you don’t have to go through it alone. Your doctor, government agencies and an experienced attorney who specializes in claim denials can help you get the care that you need. In the words of Buddha, “To keep the body in good health is a duty... otherwise we shall not be able to keep our mind strong and clear.”

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