When you are seeking medical care, it can be quite problematic if your health insurance claim is denied. Fortunately, the Affordable Care Act gives you the right to appeal against your denied insurance claim.
Moreover, your insurance provider is obligated to reveal the reason why your claim was not accepted. Let’s check out some tips and good practices provided by Your Insurance Attorney that may help you to increase the probability of your appeal to be successful.
Tips for Appealing a Denied Insurance Claim?
- First and foremost, it is critical to understand why your claim was denied. The standard form and EOB that you may receive by your insurance provider, whether approved or denied, may contain codes which specify how they arrived at a decision. Otherwise, you may call the company and ask for the information. Your insurance provider has a responsibility to explain the reason behind your denied claim in terms that can be understood by a reasonable person.
- In some instances, a claim is denied only due to meager errors such as incorrect ID number or date, misspelled name, to name a few. You may thoroughly examine each document and look for errors. If the error happened due to your mistake, fix it and resubmit the form. However, if the error resulted due to your medical provider’s negligence, ask them to correct the error and then resubmit the claim.
- Gather all the evidence that may support your claim and help you show the services that you are seeking coverage for are essential for your health. Any relevant information, prescription, or medical history can play a pivotal role in your claim being accepted or denied. Thus, you must ensure that you have complete medical records before appealing.
- Once you submit an appeal pertaining to your denied claim, it is imperative that you adequately take follow ups about your case. For instance, if your agent tells you that it will take 10 days for resubmission of your claim, add this to your calendar and timely follow up to check the status of your application.
- Getting your claim denied can be distressful and quite overwhelming as well, especially if you have to undergo necessary tests or procedures. However, you must remember that the agent on the other side is probably not the reason for your denied claim. Therefore, you may treat them with courtesy as they can prove to be your ally. Letting your agent know that you understand that it’s not their fault that your claim was denied may encourage them to go the extra mile to help you get approval.
- Last, but not least, acquiring the services of an experienced insurance claim lawyer can have a profound impact on the success of your claim. Your attorney will use their expertise and skills to ensure that your appeal is free from errors. Moreover, a skillful insurance claim lawyer will protect your rights and construct a solid case on your behalf to present to your insurance provider. In addition to that, your insurance claim lawyer will be well-versed with the technicalities and requirements of your insurance company, hence they will gather relevant information and evidence, which may help expedite your application process.
Your Insurance Attorney
These tips may help you to file an effective appeal pertaining to your denied insurance claim. Furthermore, seeking help from a professional insurance claim attorney may further improve the chances of a successful claim. If you wish to learn more about this subject or schedule a consultation, then contact Your Insurance Attorney to talk to an experienced insurance claim attorney.