Can I Appeal an Insurance Claim?

People are often mortified by the idea of having to appeal an insurance claim after a denial. But, the truth is, you can win if you have a legitimate case and a good car accident lawyer in Indianapolis who has worked with denied claims.

Health insurance companies, no matter what you think, are not working to cheat you. Many times they deny the claim because of things such as missing information, misunderstanding, coding errors, or omissions.

Let’s see how you can appeal an insurance claim that got denied.

Why Was Your Health Insurance Claim Denied?

If your claim was denied, call the insurers and seek an explanation. They should send you a detailed explanation of why they denied the claim.

If there is an error, the insurers will try to fix it. Make sure you check it twice to be sure things are clear. 

When you know why they denied the claim, you can easily appeal the decision. If the appeal goes through, the insurance company will pay for the claim, even though they decided to deny it in the first place. 

Usually these are the reasons for denying the claim:

  • Incomplete or missing info in the submitted claim documents (medical billing errors, for example).
  • Surpassed coverage limits in your insurance plan.
  • Your health insurance might not cover what you are claiming; the procedure might not be seen as essential for your injuries.
  • You might have used “out-of-network” providers, but your health plan works with “in-network” providers only.

Carefully Read Your Policy 

People don’t tend to read carefully what their health plan covers and later are surprised their insurers denied the claim. 

When you know what you can get and what claim you can file in for, things will be easier. 

Your health insurance usually includes a summary of benefits (what most people read online). Make sure you read the entire policy. 

Keep the policy in a place where you can always find it and read it over and over again.

Deadline to Appeal an Insurance Claim Denial

While you are reading your health plan, make sure you remember the rules for filing an appeal. There are deadlines for that, too, as well. 

You would not want to miss them, and if your case is complex, send your insurers a letter telling them that you are appealing the denial and that you will send them more information soon.

Prepare Your Case

When you are preparing your case for your appeal, make sure you get every document that will work for your argument. 

Make sure you read your diagnosis as well because sometimes a wrong diagnosis could be the main reason why your insurers denied the claim. 

Submit all the copies from your medical reports, diagnosis, X-rays, letters from your doctors, and just anything you believe will work your case. 

Your Appeal Letter Must be Clear and Full of the Pproper Information

When you write an appeal letter, the first sentence should inform the insurers that you are appealing to their claim denial. In the body of the letter, explain why your medical bills should be paid. Finally, demand the payment and include the necessary information.

Your address, full name, insurance number, date, and year of birth should be included as well. Also, state the services that were provided and the health insurance claim number.

This letter is not about begging, trying to explain how terrible your situation is that you deserve that claim, and so on. Just use cold hard facts. 

Be realistic about it; your insurers don’t really care how horrible the whole situation was for you. They need facts so they can check your case; nothing else is important. 

Try Again

Even if your appeal is denied, you can still try again. Find out why the insurer denied it. Check what other information you need to provide to get your appeal approved. 

If the appeal is denied the second time and you are already tired of trying, you can always take the case to the state department of insurance (this can be done unless your insurance coverage is through a self-insured employer).

If your employer is self-insured, take your case to the U.S. Department of Labor, but expect that including federal officials in your case may be a lengthy process. 

Does this sound like a torturing and long process you don’t think you can do alone?

It is time to hire a professional car accident and claim law firm. Our team is here for you and is expecting your call.

View these other frequently asked questions pages:

Important Information About Indiana Auto Accident Compensation Laws

Personal Injury Case: How Do Lawyers Prepare Witnesses?

Car Accident: What Should I Do Immediately After?


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