It is frustrating to visit a doctor, knowing your insurer will cover the cost of treatment, only for the claim to be denied later. A denial of claim does not mean it cannot be reversed. The claim may have been deemed not necessary, or the denial may simply be due to a clinical error. The following steps will help an insurance policy holder whose claim has been denied.

Make a Call

When your health insurance claim is denied, the first thing you should do is contact your insurer to find out why the claim has been denied. The reason may be simply because there is some incorrect or missing information. If this is the case, you do not need to appeal. Simply resubmit the documents with the correct information. If the reason for denial is due to a more complex reason, you can start the appeal process.

Appealing the Denial

To start appealing the denial of claim, find out from your insurance company's representative what the requirements to file an appeal are. The procedures differ between companies but are quite similar. Get the representative's name and employee ID when you contact the company as well. Take note of the date and time of the call so that there is a record of your appeal process. Get the mailing address of where you are directed to send your letter of appeal. Usually, the claims and appeals department use different addresses.

The Letter of Appeal

The next step is to write a letter of appeal. In the letter, include all the details relevant to your appeal. Indicate your insurance member ID number, the claim number, the date of service, the procedure that was performed, and the amount due. Make sure you provide any supporting documents such as doctor's referrals, medical records and so on. Also, get a note from your doctor indicating that the procedure that was carried out was medically necessary.

Mailing the Letter

The appeal letter is important, and should be mailed via certified mail with a return receipt. It is also best to use insured or certified mail; as it will be easier to track who received the mail, since the recipient has to sign for it. Insurers usually have many claims and it is not unusual for them to "lose" appeal letters. Moreover, should an insurance policy holder need to pursue legal actions against the company, proof of mailing will be required.

Having a health insurance claim denied can be frustrating. If it, however, is a clerical or billing error, resubmitting the correctly filled documents will resolve the problem. If it is a more complicated problem, you will have to appeal it.