Insurance companies deny claims, such as automobile, medical or dental claims. Most companies send letters that explain their reasoning. Denial notices usually describe the appeal process, including contact information about the appropriate department. Your benefits handbook also should explain the process.
Instructions
1. Contact your insurance company's customer service department and ask for clarification. While the denial notice often provides an explanation, you might obtain more information by speaking to a representative. Ask about appeal deadlines like if you have to file your claim within 90 days.
2. Gather evidence to support your position. If your insurance company denied medical treatment because the services were excluded or not necessary, carefully review your policy. Speak with your physician, and ask about alternative options (e.g., if a different drug can function as well).
3. Prepare an appeal letter that includes your name, policy number, and address, along with a detailed explanation. Avoid simply asking for reconsideration (e.g., the denial is wrong) without describing your reasons. Logically organize the factors behind your request.
4. Contact your state's Health Insurance Assistance Program to receive help in filing an appeal. SHIP usually is part of the state Department of Insurance, which might have additional resources. For instance, Michigan's Patient's Right to Independent Review Act a third-party review of denied medical claims.
5. Consult with a local attorney who handles denied claims, such as for life or disability insurance. Some attorneys work on a contingent basis, meaning that you do not pay any fees unless you win.
