Mansell, Engel & Cole

What should I know about appealing a denied claim? Pt. 2

In a recent post, we shared some basics about appealing a health insurance claim denial. We covered some of the common reasons why a health insurance provider might deny a claim. If you have been told, for example, that a treatment isn't covered because it isn't medically necessary but your doctor will argue it is, then you may have a valid reason to appeal. 

There is more than valid reason that must go into an effective appeals process. As in many types of legal cases, the process of appealing a denied claim relies on specific time frames. Understanding and meeting time requirements is much easier with an experienced insurance lawyer in your corner, helping to navigate the details of the thorough process.

What are some of the time restrictions that you or a loved one must follow when fighting for the coverage of an insurance claim?

  • If you plan to get a treatment or procedure done in the future and are looking for your provider to cover it, you need to approach them with the request for coverage. From there, your provider has 15 days to respond in writing regarding whether they will change their mind and cover it or continue to refuse coverage.
  • If you've already received treatment and your provider has denied its coverage, the company has 30 days after you've filed a claim to respond in writing.
  • If your medical case is especially time-sensitive it may be considered an "urgent care" case. In these situations, a provider must respond to a filed appeal within 72 hours.

Are you unsure about what you need to do following a denial of health care coverage? If so, you are not alone. You are not foolish. Insurance matters are complicated, and insurance providers can put up a frustrating fight in order to try to save themselves money. Contact an insurance lawyer whom you trust to defend your interests and stand up to your insurance company.

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