How to Dispute a Medical Service

A health insurance company can deny you medical service for a variety of reasons, including treatment for pre-existing conditions and procedures and therapies that are deemed medically unnecessary. Insurance claims may also be denied because of billing, computer or human errors. When this occurs, you are likely to receive a denial letter along with a bill for the entire cost of your medical service. You do have the option of disputing the claim.

Things You'll Need

• Denial letter
• Insurance card

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Instructions

• 1

  Review your bill and explanation of benefits. An explanation of benefits -- or EOB -- is sent to you after each medical service you receive. This paper explains what your insurance company covers and what you are responsible for financially as the patient. Look for errors in your personal information -- name misspellings, incorrect addresses, wrong date of birth and incorrect subscriber information. If any of this information is incorrect, your claim may simply have been denied for this reason.

• 2

  Contact your insurance company. Call the 1-800 number on the back of your insurance card. Speak to a representative about your dispute. If you have any errors on your bills or EOBs, have the representative correct them at this time. If your claim was denied for another reason, ask for an explanation and the specific steps needed to appeal your claim. Steps may vary by insurance company.

• 3

  Call your doctor's office. If your claim was denied because of an error in your information, ask the office to resubmit your claim with the correct information. If you are going to need to dispute the claim, ask your office's policy. Some offices will start the process for you. If you will need to file an appeal on your own, ask to have a copy of your medical records sent to you.

• 4

  Talk to your doctor. Ask your doctor about the medical necessity of your procedure. When your doctor feels that a procedure is necessary, he or she is likely to write a letter to your insurance company explaining how the procedure is necessary.

• 5

  Write a letter disputing your medical claim. Include your name, demographic information, reason for the denial, reason why you or your doctor feel that the claim should be covered and what you would like the insurance company to do -- reconsider covering your claim. Include any supporting documents, including a letter from your doctor or your medical records.