Write a Health Insurance Claim Denial Appeal That Works

March 26, 2024

Health insurance claim denials are a problem that many in Oklahoma City and across the state deal with daily. Health care is costly.  When claims are denied, one of two things results:  either the individual whose claim was denied does not receive the medical care they need, or the financial burden of paying for necessary treatment falls upon the individual themselves. When a claim is unfairly denied, neither option is acceptable. Unfortunately, many simply don’t know how to respond appropriately.

In cases like this, addressing the denial with an appeal letter is the first course of action. Completing this task appropriately is important, as errors in the process may result in the insurance company’s refusing to review your case or denying your claim once again.

Engaging the assistance of a health insurance claims lawyer in Oklahoma City can help ensure that your appeals letter contains all the necessary information and is submitted correctly.  Understanding how to write this letter is important — its contents matter.

Taking the Right Steps Can Positively Impact Your Health Insurance Denial Appeal

If your health insurance claim has been denied, you don’t have to accept this decision as final — you have options. Writing a health insurance claim denial appeals letter is the first thing you must do.

That said, there are certain steps you will want to ensure you take to maximize your chances of success.

Poorly written letters with missing information will not help your case.

Make sure to take the following actions to create direct and appropriate communication.

Understand Why the Insurance Company Denied You

When embarking upon an appeal, the first thing you need to do is to recognize why your health insurance claim was denied.  To be honest, insurance companies deny medical claims every day.  Paying them completely and in a timely fashion is simply not good for their business. These claims are recognized as expenses and decrease the company’s profits.

In order to write a letter that addresses possible bad faith actions or errors, you must fully understand why your claim was denied.  Some of the possible reasons may be:

• Out-of-network provider
• Medically unnecessary treatment
• Care is not covered by your plan
• Absence of preauthorization
• Treatment is categorized as experimental.

Sometimes the reason behind the denial is valid, while at other times insurance companies operate in bad faith.  Completely understanding their reasoning can provide important direction for your claim appeal letter.

Gather Information Like Policy, Medical Records and the Denial Letter

When writing a health insurance appeal letter, you want to have access to all relevant documentation. First, you should have a denial letter; this way you know exactly why your claim was not paid. Second, make sure you have a copy of your health insurance policy. If your claim was denied on the basis that your plan did not cover your treatment, you will want to refer to the policy to confirm that statement. You also may want to refer directly to specific policy language as you draft your appeal.

Finally, you will want to have access to all of your medical records. Double check to make sure the submissions were correct and that your doctor provided all necessary details. You likely can download your medical records from your physician’s portal, or you can request a hard copy directly from their offices.

Attach All Documentation

It goes without saying that all health insurance appeals should be conducted in writing. When submitting your letter of appeal, it is best to attach copies of all relevant documents (including their initial denial letter).  While the insurance company may have access to everything, you want to make it as easy as possible for them to review the important details.  You also can refer directly to the attachments in your letter, making cross-referencing simpler.

Critical to the success of the appeals process is submitting your letter in the manner in which the insurance company requires.  While some will accept appeals via email, others will want them uploaded to a portal, and still others may require that hard copies be mailed to them.  Make sure that you research the correct mode for your specific insurance company and case.

Keeping track of when you sent your appeal is important; you will want to follow up if you do not hear back within a reasonable time.

Get Professional Assistance if Needed

Insurance denials are frustrating; they delay necessary treatment and leave policyholders burdened with the excessive costs of care. Filing an appeal can be frustrating and doing it correctly can be overwhelming. In many cases, working with a professional can prove valuable.

Engaging a reputable health insurance claims denial attorney can reduce the burden on you, ensure that your appeal will be handled appropriately, and increase the chances that your voice will be heard.

Health insurance companies reply more quickly and more positively when an attorney is making requests. They know that most lay people don’t understand the legalities surrounding insurance claims; after all, the laws are complicated, and the language is confusing. But having a professional on your side often means your case will be taken more seriously.

Attorney Doug Terry Can Help Manage Your Health Insurance Denial Appeal

He Knows Oklahoma Law and Has Experience Managing Cases Like This

Attorney Doug Terry  and his team have decades of experience handling appeals for denied health insurance claims in Oklahoma. He understands the complexities involved in the process and is well-versed in the laws.  He and his team have earned a reputation for providing high quality, compassionate service to those who are struggling with their insurance companies. He knows how overwhelming the process can be and appreciates his clients’ concerns for their health, well-being, and financial future.

If your health insurance claim has been denied, reach out to Doug Terry Law today at 405-463-6362 to schedule a free consultation. He knows what to do if your health insurance claim has been denied. This meeting will provide you the opportunity to see, firsthand, how he communicates and learn how he would approach your specific situation.