Health insurance companies are becoming selective when paying their insurance settlements or claims. According to the Department of Labor, approximately one out of seven health insurance claims are denied upon initial review.
If your insurance claim gets denied, you may have to some homework. Start with the insurance company – not the health insurance broker. Even though the broker may advise you on the best approach, health insurance brokers generally are not involved in the appeal process.
There are two main reasons for health claim denials – incorrect coding or the procedure is determined to be medically unnecessary. If you think your claim was denied for one of those reasons you may want to consider an appeal.
Sometimes appeals are successful and sometimes they go unresolved. If you do some research before you start the appeal process you may increase your chances of success. Have as many facts available as possible. Make sure you talk with the people who have the authority to make changes. And, do not get discourage, appeals can be a long process.