3 Solutions for a Denied Medical Insurance Claim

It can be frustrating to have an expensive medical bill denied by insurance. Sometimes this happens due to a mistake from the doctor’s office, a mistake from the insurance company, or a misunderstanding of your insurance coverage. Solutions range from a quick phone call to an appointment with a Denver personal injury lawyer. Consider these options before slipping into medical bill debt.

Call Your Doctor

Insurance processes claims based on information and codes received from doctors and medical facilities. Patients often do not have direct access to this information or the knowledge to interpret the codes, but the doctor or medical facility should be able to confirm that the correct information was sent to the insurance company. Over the phone or through a secure online message, let the billing department know that your insurance claim was denied and ask them to check that the procedure information sent to the insurance company is accurate. If there was a typo or miscommunication on their end, they can correct the error and re-submit the claim to the insurance company for reprocessing.

File an Insurance Claim Appeal

Insurance companies are legally required to allow customers to appeal decisions about whether or not an insurance claim will be covered under the customer’s policy. The process for submitting a claim varies by insurance company, but the general idea is the same. You can contact your medical insurance company by phone, and many larger insurance companies have a process for appealing a decision through their website. Prepare to explain what the bill was for, why it was necessary, and why you believe it should be covered under your policy. Doing a bit of homework beforehand can save you time and make a compelling case that the insurance company can easily understand.

Hire a Lawyer

If the medical billing department confirms that the correct information was sent to insurance, and the insurance claim appeal was unsuccessful, it might worth hiring a lawyer to take your case. If medical malpractice was a factor or if there is some type of discrimination in the decision to deny the insurance claim, a lawyer can help you sort through the details and determine the best course of action. Some lawyers advertise that they will not charge you unless you win your case, and some require payment upfront. Be sure to research lawyers in your area and reach out to a reputable lawyer or law group with experience in your situation.

Having a medical claim denied by insurance can be a scary situation, but the decision can often be reversed. Don’t panic and remember that you do have options.

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