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Health insurance is in place to protect you and provide the benefits you need when you get ill or suffer an injury. Unfortunately, not all claims will be accepted by your insurance company. In some cases, it could be due to a clerical error, so it is important to know what is in your policy and try to pinpoint why your claim was denied. Here are some things to do if your claim was denied.
Ask for a Written Explanation
If you received a denial that did not give a specific reason for that denial, you can ask your insurance company for a written explanation. Make sure it is in writing, as you might need that later when filing an appeal or getting a lawyer. Even if there aren't legal requirements in your state for an explanation as to why you were denied, most insurance companies will still provide the reason. This gives you somewhere to start.
Review Your Policy
When you get the explanation, it might mention something about the medical care not being covered under your health insurance policy. If you believe this is untrue, you will need to go through your policy thoroughly and find that section that describes the type of treatment you received. For example, if you have a group insurance plan that you thought covered a certain number of chiropractic treatments and the insurance company claims it is not covered, you will need to find that section in the policy.
Contact the Doctor or Medical Facility
The claim was most likely filed by a medical facility, hospital, or doctor's office, so you should check with them to be sure to clerical errors were made. Ask for details about the claim they filed with your insurance company and make sure it was filed accurately. If they used the wrong medical code to describe the procedure you had, it might be that the insurance company received inaccurate information, which is why you were denied. If so, they should submit the correct information to your insurance company.
Contact the Insurance Company
If you have done your research and believe it was an error on the insurance company's part, it is time to contact them. You can start by contacting them on the phone, but if that doesn't work, write them a letter. Include all the information you have compiled, including the reason for the denial and why you believe it is inaccurate, your policy number, bills, and any other information you believe to be relevant.
In most cases, the insurance company will correct their error. If not, you may need to file an appeal to get the benefits you need.
To learn more about group health insurance, contact a company like Fiscal Fitness.Share