What to Do If Your Health Insurance Claim Gets Denied

If your health insurance claim gets denied, don’t panic. It doesn’t always mean you have to pay the full bill. Insurance companies sometimes reject claims for simple reasons like missing info, wrong codes, or small mistakes. The first step is to read the denial letter carefully. It will tell you why the claim was denied and what you can do next.

Sometimes the reason is something small—like the doctor’s office used the wrong code, or the insurance company needs more documents. Call your doctor’s office and ask if they can fix the error and resubmit the claim. This is a common problem, and often it gets fixed quickly.

If the denial is about something bigger—like the insurance company says the treatment isn’t covered—you still have options. You can file an appeal. This means you ask the company to look at the claim again. Most insurance plans must give you this right. The denial letter will usually tell you how to appeal and how many days you have to do it.

Before you send your appeal, gather everything you can. That includes the denial letter, your doctor’s notes, bills, test results, and anything else that proves the treatment was needed. Write a short, clear letter explaining why you think the claim should be covered. Ask your doctor to write a letter too if possible. Their words can carry weight.

If the first appeal is denied, you can ask for a second review. Some plans also offer an outside review by an independent expert. This can help if you feel the insurance company is being unfair.

While this process is going on, keep copies of everything you send and write down every phone call you make, including dates and names. This helps if there are delays or if you need to take it further.

In some cases, your state’s insurance department can help if you can’t resolve the issue with your insurance company. You can file a complaint with them, and they’ll step in to help.

Most important—don’t give up right away. Many claims that are denied at first get approved later after an appeal. It takes a bit of time and effort, but if you stay organized and speak up, you might not have to pay that bill out of your own pocket.

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