When a health insurance claim is rejected, your next steps will determine whether you win a reversal in your favor or get stuck with a big bill.
Contact your health insurance provider.
A claims adjuster should be able to review the denial and resolve the issue if there was just a simple error, such as an incorrect diagnostic code.
Make sure to keep a written record of your call, including the date, time and name of the person you spoke to.
If you don't get anywhere with the phone call, request to begin the process ofa formal claim review.
Ask for help.
Take the details to your human resources department or benefits administrator.
She/he should be able to call the insurance company for you or offer advice on how to proceed.
You might also want to ask your doctor to call or write your insurance company to specifically explain why you needed the care you received.
Draft a letter.
If the claim is still denied, write a letter to the claims manager and send copies to higher ups, such as regional vice presidents.
Call your health insurance company for names and proper spellings.
Politely explain why your claim should be covered and request a written response by a certain date.
Apply some pressure.
If you still feel that your claim is legitimate and your insurer disagrees, file a complaint with your state insurance regulatory agency.
Many states allow you to do this online.
To find your state regulator, go to naic.
org