Skip to main content

What To Do If Your Insurance Claim Is Denied?

By January 26, 2024February 6th, 2024Insurance

Having your insurance claim denied is upsetting. Whether it be a denied health insurance claim or a denied car insurance claim, it makes you ask yourself, “What am I paying insurance for if it is going to get denied!?” This is never a nice experience, and we are so sorry you are experiencing this.

Steps To Take If Your Insurance Claim is Denied

Let’s take action to prevent this from happening again and see if there are any options to correct your denied insurance claim. The good news is that receiving a denied claim is not the end. There is still a chance you can get your claim accepted.

Step 1: Determine Why Your Insurance Claim Was Denied

Many times, an insurance claim is denied simply because there wasn’t enough information. It may need some deciphering, but the refusal letter should clearly state the reasons for your insurance claim’s denial. Clerical mistakes, such as a misspelled name or an incorrect policy number, more complicated problems, or the service not being covered by your insurance plan is frequently why insurance companies deny a claim.

Step 2: Correct The Issue Resulting In Your Claim’s Denial

Once you find out why your insurance claim was denied, correct the problem. If it was a simple clerical error, fix it, and request your claim be reviewed. If you were denied because your insurance claims it was not part of your insurance coverage, it is time to reveiw your insurance policy.

Step 3: Review Your Insurance Policy

Reading through your insurance policy can be challenging and difficult since a lot of the language and industry jargon is difficult to understand. To get the most of your coverage, you must fully comprehend it. Check for inclusions, exclusions, and any requirements you may have for particular services or treatments. This stage can demonstrate that the denial was the result of a straightforward error or misinterpretation.

When reviewing your insurance policy in this way it will result in you having a more clear understanding of what is covered in the future.

Step 4: Appeal Your Denied Insurance Claim

You’ve done your homework; how can I get covered now? An appeal is your opportunity to provide facts and make an argument; it’s much more than just a well-worded email. First, compile as much information as you can. If you were denied by your health insurance, you should include medical records, physician notes, and any additional files pertaining to the claim if it was car insurance, dates, costs and past coverage details.

You will need proof that they cannot refute. Writing a succinct, understandable appeal letter is the next step. You must explain in this why the rejection ought to be reversed, using particular passages from your policy to bolster your position.

Step 5: Waiting For Your Insurance Appeal To Be Reviewed

You can expect to wait after sending your appeal. Remember that these things take time, so don’t lose sight of your claim. Repeatedly and respectfully follow up. Record your discussions, including who you spoke with, what you said, and any reference numbers you may have used. Be persistent and don’t let them forget who you are and the details of your insurance claim.

Pennsylvania Seeking To Alleviate Denied Insurance Claims

Pennsylvania government recognizes the challenges its residents face with repeatedly denied health insurance claims. To help, they have created a new website and focus of their insurance department to assist you in your claim’s denial.

“Pennsylvania’s insurance and digital services agency announced a new website where Pennsylvanians can request independent, external reviews of denied health insurance claims.”

How Strickler Insurance Combats Denied Insurance Claims

At Strickler Insurance, we work with you to ensure you understand what your insurance covers and protects. In many instances, medicare insurance can be complicated; that is why we have a dedicated team member to help guide you in Medicare coverage. When a claim is denied by one of our carriers, we work with our customers to see why it was denied and if there are any other options. Contact Strickler Insurance today for professional insurance services.