Mansell, Engel & Cole

Appeals are not the only option for denied insurance claims

Needing medical care can be complicated in many ways. You may worry about the procedure, medication and other aspects of treatment, and you may also have concerns about how you will pay for it all. Of course, because you have health insurance, you believe that your insurance provider will help cover at least a portion of the costs.

When you filed your claim with your insurance company, you may have anticipated having to wait a short time before you gained information on how much the insurance covered. However, what you may have not expected was for the company to deny your claim altogether. This information may have shocked you, and you may feel a bit panicked at the idea of having to pay for the entirety of your medical costs out of pocket.

Do not panic yet

Before your mind begins reeling, remember that you may have the ability to appeal the insurance company's decision. If you believe that your policy should cover your claim, you may want to take the following steps to work toward a successful appeal:

  • Go over your insurance policy again to make sure it covers your treatment.
  • Call your insurance provider and discuss the matter, including why they denied the claim and how you can appeal.
  • Gain information on the appeals process and file the necessary paperwork.
  • Talk with your doctor about your bill and see if you need to make payments even before completing your appeal to avoid collections.
  • If the insurance company rejects your appeal, look into obtaining an external review in which an outside party goes over your claim and the denial.

At first, you may think it is hopeless or even unnecessary to keep pushing an insurance company to cover your claim, but you may want to remember that these companies can act in bad faith and unjustly deny your claim. As a result, pushing for an acceptable outcome is not a futile endeavor.

What else can you do?

If you do file an appeal and it comes back denied, you are not out of options. You can contact an Oklahoma insurance law attorney who can go over your policy, claim and denial and determine whether the company may have acted in bad faith. If so, you may have reason to move forward with a legal claim to rectify the situation.

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