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Health Insurance Claim Denied? Here’s What To Do Next.

The Process You Should Take in Cases of Denied Health Insurance Claims

The Process You Should Take in Cases of Denied Health Insurance Claims

If you are in California, you know how frustrating it is to deal with health insurance companies. We have all heard stories of people who have been denied care despite being gravely sick. People have their prescription drugs, necessary medical tests and even treatments denied. However, denied health insurance claims do not always stand on legitimate grounds. Insurance companies, including Medicare, sometimes deny legitimate claims. The consequences of these denied claims is grave. It leaves people ill and leads to devastating deterioration to their health. Sometimes it leads to their death.

Steps to take in the case of a Denied Health Insurance Claim

In the unfortunate event that your health insurance claim was denied, you should find out why. The first step is to learn the insurance company's reasoning and basis of denial. Companies are legally obligated to provide you with such information if you request it. However, if you skip this step, they may not inform you. You can request such information by calling a customer service representative at your health insurance provider. Your next step is to review your health care policy. Reviewing your policy will help you determine whether your claim should have been covered, despite its denial. Sometimes, all that you need is to resubmit the claim using a different billing code. You can do that by finding out if your doctor needs to resubmit with a letter supporting what is needed. However, if this step deems unsuccessful and your claim is denied again, you may need to file an internal appeal.

Filing an Internal Appeal after a Second Denial of a Health Insurance Claim

The good news is that you do not have to do this alone. You can retain a perosnal injury attorney to help you with this. However, many choose to do this on their own. In order to file an internal appeal, you must organize all your paperwork and turn it in before the deadline. Have copies of all the correspondence and medical rec ords and bills. If you speak with anyone over the phone, make sure to record their names, dates and details of the conversation regarding the denied claim. Here is your to-do list for an internal appeal:

  1. Request a formal letter that explains why your claim was denied
  2. Write a formal letter that appeals the denial of the claim.
  3. In case your internal appeal was denied, you can request an independent external review. If you or someone you know are in a life-threatening medical situation, you can request both at the same time.
  4. Hire a personal injury attorney.

Contact a Medical Malpractice Attorney to fight on your behalf

If your health insurance claim was denied, and you or someone you know suffered from the lack of care, you may be able to recover damages. Contact our office today to get help from an experienced personal injury lawyer. You may be able to win this on your own. But your chances in recovering a reasonable just compensation reward is bigger with the help of legal representation. Call us today to schedule your free consultation.


Alexander D. Napolin, Esq.