Tips for Appealing a Denied Medical Claim

Medical insurance companies may reject your claim for many reasons. However, there are a few tips that you can apply to get your insurance approved.

When you realize that your Insurance claim has been denied, you are likely to panic. In this scenario, you may think your claim needs a review, so it is obvious to spend hours and hours talking with the concerned person. Although it seems crucial, you can begin by following certain steps to appeal your claim properly.

Was your Claim Denied Permanently?

For instance, first, you need to ensure that your claim has not been denied permanently. In this case, denial can be soft or hard. Moreover, in the case of hard denial, it is denied because of non covered service.

You can also file an appeal if your claim is denied permanently. On the other hand, a soft denial is when there is a need for more information. It varies from your receipts, medical record, bills, or even the claim form. If this is the case, you should not panic as it can be resolved just by consulting the relevant department.

Before you appeal for a denied medical claim, you need to sit down and evaluate the reasons why the insurance stood rejected in the first place. Look at your EOB (explanation of benefits)

Consider Filing an Appeal

Secondly, an appeal can also work for you. It is an official way to go against the decision. Take note that you should always understand the reasons that lead to claim denial. All you need is to have supporting documents that work as evidence. Write a letter explaining your situation, make sure that you are mentioning your claim number and number of your visitor insurance card and attach the required documents that may support it.

Supporting Documents

To make your appeal stronger, you need to go through what kind documents you would need. If your appeal is denied because of the incomplete or incorrect medical record, you can contact your doctor. This way, you can get the right record along with the letter of explanation. This record and explanation letter will make your appeal look more persuasive.

Moreover, you should attach the new and relevant supporting documents. If you send over reviewed documents again, they may not consider them. Take note that claim processing is carried out by licensed analysts who can interpret policy language. So, it is likely that the concerned person has reviewed your information already. In this case, new and relevant information can do the job for you. This way, they will come across the information that they don’t have before.

Similar Read: Everything You Need to Know when Visiting other Countries from the US

Stay Organized

You need to stay organized at all costs before filing for an appeal. The insurance company usually monitors your appeals and medical claims. You need to be organized efficiently to make sure that you are not missing any possible detail.

Organize all your data, paperwork, medical bills, prescriptions, and every other informational piece accurately before you Appeal.

Appeal Process Time

Once your claim is denied, it gets difficult to wait in the state of panic. And, you desire to see it get processed on an urgent basis. However, you should know appealing your claim is a time-consuming process. It might take several weeks to months. This is because an important process is conducted to evaluate your appeal. Therefore, you should wait patiently and allow this process to get the desired results.

Final Words

Insurance claim denial is a disappointing experience. It can be possible that you file an appeal and it gets rejected too. Follow the right procedure as per the instructions form the Insurance carrier to appeal your claim. In the worst scenario consider it as a valuable experience and stay careful in purchasing an appropriate plan for the next time.

Visitor Insurance or Travel Medical Insurance is short-term medical insurance designed for unexpected illness during travel. It should not be considered as regular health insurance. There are different deductibles, limits, sub-limits, exclusions, and other limitations based on the purchased plan. Before buying the policy, it is very important to go over the insurance company’s policy documents to have a better understanding of the plan benefits, exclusions, limitations, and other critical details.

Also Read: Buying Visitor Insurance and Things to Remember When Traveling Abroad

Before making a final purchase, you must thoroughly read the policy information published by the insurance carrier, including their policy brochure and certificate. The insurance company's documents provide the definitive explanation of plan features, benefits, exclusions, limitations, claims handling, and other critical details. If you find any conflicts between our website and the insurance carrier’s documents, be advised the insurer’s documents take precedence.