How to Appeal a Health Insurance Claim Denial?

Find Out Why the Claim Got Denied

Review the denial notice provided by your insurance company and try to understand the possible reason for the denial, such as a coding error, lack of medical necessity, or missing documentation.

Get In Touch With Your Insurance Provider

Call your insurance company's customer service line to discuss the reasons for the denial and seek clarification. Ask for details on the appeals process and any specific forms or documentation required.

Call Your Doctor’s Office

Speak with your healthcare provider or their billing department to understand their perspective on the denial. They may have additional information or insights that can support your appeal.

Gather All the Paperwork

Collect all relevant documents related to your claims, such as medical records, bills, receipts, and any correspondence with your insurance company, and organize them to support your case.

Submit an Internal Appeal

Follow your insurance provider's instructions and submit an internal appeal by filling out a formal appeal form and providing supporting documentation.

Wait For an Answer

The insurance company will respond to your appeal within a specific timeframe which can be up to 60 days. Be patient while waiting for the response.

Submit an External Review

If your internal appeal is denied, you need to request an external review that involves an independent third party to assess your case.