Top Tips for Getting Your Denied Medical Claim Paid

When your health insurance carrier denies all or part of your medical claim, what should you do? Here are some steps you can take to help get your claim paid. According to some insurance experts, insurers pay approximately half of denied insurance claims once appealed.

The first step is to determine why your insurer denied the claim. Most explanations of benefits (EOBs) contain a code that explains the denial. If you’re unclear after deciphering the code, call your insurer to discuss the denial in more detail. Then try to right the situation if possible. Some of the standard reasons for denial include a lack of preauthorization and incorrect coding by your physician.

Next, if needed, call your doctor’s office and speak with its insurance department. Generally, they are very experienced and may talk to your insurer on your behalf.

Resubmit your claim if the carrier denies it one time. Often, the insurer will pay the second billing or the third. Your EOB may outline procedures for appeal. However, you may have to review your health insurance policy for appeal procedures.

Finally, if you don’t get help through the appeals process and you believe your insurer owes the claim, you can appeal the denial to your state’s department of insurance (DOI). In many states, filing a DOI complaint is as simple as completing a one-page form. You’ll need to attach your records to support your appeal.

We may be able to help. Contact us if you have questions about a denied healthcare claim.