How to Challenge a Medical Insurance Claim Denial

Challenging a medical insurance claim denial can seem like a daunting task. Usually this is because you learn your medical insurance claim was denied after receiving an official letter in the mail. This letter is often flooded with legalese, making you feel as though the decision made by the insurance company is final. Do not be intimidated by these denial letters. Instead, challenge the medical insurance claim denial. Though the appeals process can be lengthy, it frequently leads to the insurance company covering the previously denied procedure. Follow a few simple steps to challenge the denial.

Instructions

• 1

  Fill out the appeal form in detail and mail it to the insurance company. The appeal form should have been sent to you along with your denial notification. If you did not receive an appeal form, contact your medical insurance company and ask that an appeal form be mailed to you. The customer service phone number should be located on the back of your insurance identification card.

• 2

  Obtain a letter of medical necessity from your physician. The letter of medical necessity should include why it is necessary for you to receive the denied procedure and why no other procedure would be adequate. Mail this letter to your medical insurance company to support your appeal.

• 3

  Respond immediately to all correspondence initiated by the insurance company. Most people change insurance carriers an average of every two years, so it is common for insurance companies to deny a claim in hopes that they will not have to pay and you will obtain a new health insurance policy before appealing the denial.