Health insurance offers great financial security for people. As you know, the cost of medical care is rising steadily. Health insurance can save you from these rising medical costs, but what if your insurance claim is denied?
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You can get the necessary medical care with the help of insurance. It might not be possible when you don’t have a health insurance plan. However, you may encounter many problems when claiming the insurance money.
You must know that insurance companies are for-profit organizations. They will try to find minor mistakes to reject your claim. If your insurance claim is denied, you need to get the help of an expert attorney to deal with these insurance companies and avoid claim rejections.
Possible Reasons Why Your Insurance Claim Is Denied
Here are some reasons why your claim may be denied:
- Improper documentation is the most common reason for insurance claim rejections. Without proper documentation, it is impossible to claim your insurance money
- Misinformation is another reason that can lead to claim rejections. Even a minor typo can get your claim denied
- Another instance where a claim can get rejected is when you forget to renew your policy. Check the policy end dates and renew the claim regularly
- If the insurance company believes that you have undergone a medical procedure that was not necessary, they may reject your claim
What To Do When Your Insurance Claim Is Denied
The actions you take following a claim denial are very important, as the right action can get you your money. Here are the steps you need to take after a claim rejection:
Step 1: Understand the reason why your insurance claim is denied
The insurer should provide you with justification for your claim rejection. They must give you a written statement within 72 hours in emergency situations. They may take up to 30 days to give you the written statement if you have already received medical care.
By reading their statement, you can understand the reason for rejection. If the reason seems to be valid, no further action is needed. But let a lawyer decide whether the reason is valid or not.
Step 2: Be persistent
Insurance wants you to give up. They follow a strategy called the 3D strategy. The 3D stands for deny, delay, and defend. Insurance companies deny your claim in the hopes of you giving up.
Do not give up, and be persistent. Follow up consistently with the insurance company regarding your claim.
Step 3: Hire an expert attorney
You need to hire an attorney to help you deal with the insurance company after a claim denial. The attorney can review your policy and the insurer’s reason for claim rejection. After that, they will formulate an action plan.
They can help you appeal your insurance company’s decision. Lawyers can protect you from scummy insurance companies.
Step 4: Appeal your claim
First, read and understand the appeal process. Knowing your insurance company's appeal process can help you prepare better. Make sure you get the help of an expert lawyer when you appeal.
They can help you avoid documentation errors and other errors that can lead to claim rejections.
Step 5: Document everything
Keep a record of all documents and relevant evidence. You need to start keeping a record immediately after your claim is rejected. Documentation can help you prove your claim.
If the insurance company has denied your claim, saying that the treatment you received was unnecessary, collect documents to counter their claim. You can do this by getting a statement from your healthcare provider.
If Your Insurance Claim Is Denied
People claim insurance only when they are in need. Some merciless insurance companies reject claims from people in need for measly reasons. You can fight these insurance companies with the help of an experienced lawyer.
The lawyer can help you appeal the insurance company’s decision and get you your money. Remember, do not appeal without the help of a lawyer. Legal representation is important to win the appeal.
If the insurance company has denied your claim, saying that the treatment you received was unnecessary, collect documents to counter their claim. You can do this by getting a statement from your healthcare provider.
Final thoughts
People claim insurance only when they are in need. Some merciless insurance companies reject claims from people in need for measly reasons. You can fight these insurance companies with the help of an experienced lawyer. The lawyer can help you appeal the insurance company’s decision and get you your money. Remember, do not appeal without the help of a lawyer, whether a dog bite or a pedestrian accident. Legal representation is important to win the appeal.
