What to Do If Your Insurance Claim is Denied
If you’ve filed an insurance claim, it can be stressful to wait for the coverage company to make its decision about your claim.
Thankfully, there are things you can do to speed up to process so you can get back on the road as soon as possible.
This article on insurance claims and denials will walk you through these steps so you can get your car repaired or replaced in no time.
Check the status of your claim
The first thing you should do if your claim is denied, or if you suspect it will be denied, is check the status of the claim. You may need a doctor’s note or other documentation in order to see what’s going on with your claim.
If you still have questions about why your insurance company denied your claim, talk to them and provide more information about what happened.
The insurer will let you know if they find something wrong and ask for more information from the person filing the claim or their provider.
Keep a copy of any correspondence related to your denial because this might come in handy later when dealing with an appeal or asking for an outside opinion.
Get a written denial
If your insurance claim has been denied, there are a few things you can do. Read the denial notice carefully and take notes. It’s important to know why the claim was denied and what you can do next.
For example, if your claim was denied because of a preexisting condition, you may need to go back with your doctor for documentation that the condition existed before coverage began.
In some cases, an appeal process is available. You will want to contact your health insurance company to find out how to appeal a decision in this case.
In any case, you should consult with an attorney as soon as possible if you believe the denial was unfair or incorrect.
You have only 60 days from the date on which your health plan denies payment or benefits before it must provide notification of its right under law to seek assistance from an Independent Review Organization (IRO).
Review the denial letter
A letter from your insurance company denying your claim can be frustrating and confusing. Here are a few steps you can take if your claim is denied.
Read the denial letter carefully for information on what was denied, why it was denied, and what you need to do next.
If the denial letter indicates that your claim was denied because of preexisting conditions, contact your agent or adjuster with specific questions about how this affects you.
You may also want to consult with an attorney or advocate who specializes in disability law or workers’ compensation law.
If there is nothing in the denial letter that applies to you, call your insurance company and ask them why they denied your claim.
You might have been given incorrect information or they might have made a mistake during their investigation into your claim.
Understand the appeals process
The insurance company will often require you to follow up with them within a certain period of time. Failure to do so may lead to denial of your claim.
You may also be required to provide additional information or documentation in order for the claim process to progress.
In the event that your claim is denied, an appeals process will allow you to present your case and make an argument for why you are entitled for coverage.
Follow-up with the insurer: it’s critical to contact your insurance company right away if they have not made contact with you by the end of their stated timeframe.
Keep copies of all communication: this includes emails, phone calls, and anything else exchanged between yourself and the insurer.
File an appeal
The first thing you should do if your insurance claim has been denied is file an appeal. The process for filing an appeal varies depending on the company, but in general you will need to provide more information and support for your claim.
Plus, once you have filed an appeal the company has 60 days from the date of denial to make a decision. Once the time has expired and you still haven’t heard anything, call them again.
Ask what their timeline is for appeals and remind them that it’s been over 60 days since your initial denial.
You may also want to ask about submitting new evidence with your next appeal so that they have all the details they need before making a decision.
Gather supporting documentation
It’s not a good feeling when your insurance company denies your claim. You need to make sure that you have all of the relevant documentation before reaching out and submitting an appeal.
The first thing you should do is read through the denial letter carefully, highlighting any key points in the document that you want to address in your appeal.
Don’t be afraid of asking questions either; some people are denied because they didn’t provide enough information, and others because they didn’t submit their documents on time.
When gathering your supporting documentation for an appeal, it’s important to include as much information as possible.
Submit your appeal
So you filed an insurance claim and it was denied. What do you do now? That depends on the type of insurance coverage you purchased.
Here are a few things to keep in mind:
-Determine if your denial is due to a pre-existing condition.
-Call your provider and ask for an appeal, which usually needs to be submitted within 30 days of the denial notice.
-Don’t give up! Sometimes even if you have a pre-existing condition, some plans will provide coverage after certain waiting periods.
Talk to your provider about what options are available to you before deciding whether or not to file another claim.
Follow up on your appeal
If you don’t get the results you want on your first appeal, don’t give up. Contact your insurance company and tell them why they should reconsider their decision.
Provide any additional information that could have been missed the first time around. It might also be helpful to ask for a supervisor or customer service representative during this call.
Keep in mind that it’s not uncommon for the same issue to be disputed with more than one insurer, so you may need to make multiple appeals if your claim is denied by more than one company.
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