From just 2015 to 2017, over 40 million health insurance claims filed by Americans were denied. This can create a lot of stress and fear in families, especially if the claims are expensive. Residents of Nevada should know what steps to take if their claim is denied. Sometimes, for example, utilizing the appeals process can lead to success.
Steps to take
Once you receive notice that a claim was denied, the first thing to do is find out why. Sometimes, denials are due to nothing more serious than a paperwork error. If you made a mistake in the process of filling out a form, that can be easily remedied. Or, if the medical office accidentally used the wrong code, they may be able to resubmit the form on their end.
A formal appeal
Making a formal appeal can involve both an internal and external review of the issue. An internal review will be done by the insurer. External reviews are completed by a neutral third party. External reviews are regulated at the federal and sometimes state level.
In some cases, an insurer may not be acting in good faith. They may be trying to deny a claim that should be covered according to their contract with you. Insurance bad faith coverage disputes are actually a large problem throughout the country and in many areas of the insurance industry.
If you’re struggling to get answers from your health insurer, it’s prudent to contact an attorney. They may be able to tell you if you have a good case and help you understand the best way to move forward.