How to Appeal a Denied Health Insurance Claim

When you receive a denied health insurance claim, it may still be possible to get the claim paid by your health insurance company. Sometimes getting a denial can result from a simple processing error. For more complicated issues, a denied health insurance claim can be appealed. This may sound like a difficult undertaking, but it does not have to be.

Things You'll Need

• Health insurance card
• Claim denial letter (likely called an Explanation of Benefits)
• Phone
• Computer or pen and paper

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Instructions

• 1

  Call your health insurance company. There should be a number for member services or customer service on your insurance card. Have ready the document that you received denying your claim. This document is most likely called an Explanation of Benefits (EOB). If you do not understand why the claim was denied, ask the customer service representative. Sometimes claims are denied due to processing errors or missing information. If your claim was denied for one of these reasons, then you probably do not need to file an appeal. If you are disputing the reason for the denial, then you will most likely need to proceed with an appeal.

• 2

  Ask the insurance company representative what will be required in order for your appeal to be considered. Take notes of important information. Be sure to obtain the address to which you will need to mail your appeal letter, as it may not be the same as the address to which the original claim was submitted.

• 3

  Write your letter of appeal. Include relevant details but be concise. Important items to include are: the date, date of service, claim number, your member or subscriber ID number, your group or policy number, the name of the provider (doctor or facility), and the billed amount. Explain the reason for your letter and what you would like to see happen. Include any supporting documentation that you may have, such as medical records.

• 4

  Send your appeal letter by certified mail and request a return receipt so that if the appeal is lost you have proof of mailing it and the date that you did so.