With the skyrocketing cost of healthcare in the U.S. many Oklahomans are grateful that they have health insurance. However, when a claim is sent to the insurance company, and the insurance company denies it, it can quickly lead to worry and frustration. After all, we pay for health insurance specifically so that our medical bills will be covered. The following are some steps you can take if your health insurance claim was denied.
First, it is important to find out why the insurance company denied your claim. You can contact your physician, the insurance company or the medical facility where you were treated. Your claim may have been denied due to inaccurate insurance information, the absence of prior authorization, coding errors or late filings, among other reasons. Knowing the costs of the treatment the denied claim is based on is also important, as it can help you identify why your claim was denied.
However, it is important to recognize that a denial does not have to be the end of the story. A denial can sometimes be reversed. Your physician, a hospital patient advocate or your attorney can work with your insurance company to address the denial. You or your physician may need to submit paperwork to have the denied claim reversed, so having the right advocates in your corner is important. You may also need to reapply — sometimes more than once — in order to resolve your denied claim.
When filling out forms, writing letters or reapplying a denied claim, it is important to keep a digital paper trail of all efforts you or others make to reverse your denied claim. Any questions you may have for your insurer should be clear and unambiguous.
Ultimately, you may need legal help to resolve a denied health insurance claim. Many of these resolutions are negotiated, and attorneys understand your rights. Medical care is expensive, so it is important that our health insurance companies cover all costs they are supposed to in good faith.