How to Appeal an Insurance Claim – Insurance Claim Denied

When your claim gets denied, the next thing that comes to your mind is how to Appeal an Insurance Claim. You may not need to file a claim until the property covered by your policy gets damaged or stolen.

How to Appeal an Insurance Claim

In this article, you will be given the details you need to know about this topic. So, keep on reading.

How to Appeal an Insurance Claim

There are many things that could lead to your claim being denied. Sometimes, there could be an error on your part when the claim was being filed. Other times, you may not have provided enough evidence to back up the claim.

Most insurers indicate how their clients can appeal the policy. You can do this by first calling your Insurer’s Representative. If you are not successful at this first level, you can go ahead to involve an independent third party.

How to Appeal an Insurance Claim Denial

It may be frustrating when your Insurance company refuses to accept your claim. If this happens, you don’t need to panic, you have the right to file an appeal against the denial. The steps below will help you do so:

  • Go through your Insurance Policy. This is the document attached to your insurance. Take note of what your policy covers.
  • The next step is to review the denial letter sent to you by your insurance company. It should state why the claim was denied and how you can appeal it.
  • Gather the necessary documents related to your insurance policy such as the Summary of Benefits Coverage (SBC), the policy and your denial letter.
  • After this, contact your insurance company. This should be done to find out if the denial was deliberate. It could be a billing error or missing information.
  • When you have contacted your insurer, you need to keep a record of the name of the representative, the date and everything that was discussed over the phone. Do this also for every other phone call you will make with your Insurer’s representative.
  • If your insurer is still persistent, you will have to ask for an external appeal from an Independent Third party. The Third party is a representative that does not work with your Insurer.

The third-party insurer will do their own review and help you with the appeal process. You have about four months from the denial of your internal appeal to file an external appeal.

Insurance Claim Denied

There are some precautions you can take to prevent your Insurance claim from being denied. You should know exactly what your policy covers by studying your Summary of Benefits. If it is health insurance, you can call your insurer before getting treatment.

Also, you need to review your insurance documents carefully to know the limitations of your policy. If it is a health insurance plan, you should ensure your care provider participates with your health plan as this can prevent denial.

When you are contacting your insurer to appeal a denied claim, make sure you have an already prepared list of questions to ask the representative.



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