We all pay insurance for one purpose – to have a better financial capacity when a large expense is needed. When you are an honest payer with on time payments, it can be dejecting to receive an appeal denial letter even after the work you put through in getting the documents together. However, there are more people out there going through the same thing. What you need to do now is calmly read the letter and figure out your next steps.
Step 1 Understand The Letter
Once you get the denied appeal letter, read through it and determine the reason for denial. Before this happens, most insurance companies contact the policy holder for concerns that can be easily corrected such as lacking documents and wrong entries. Which is why you can expect that the reason in the denial letter won’t be a simple misrepresentation of documents. You have to figure out if the company’s claims are true and that there is nothing you can do about it. But if you think you can still appeal denied health insurance claim, proceed to step two.
Step 2 Determine What You Want
When you receive the letter, you will be emotionally affected. Gather your thoughts and decide whether you should leave it at that or complain to your insurance company. This is after you make sure you actually have enough grounds to make a complaint. If you know someone who can give a second opinion about your situation, do so. A lawyer would be a good choice. Show him the appeal denial of summary judgment. Once you know the facts, decide if you want to appeal denied insurance claim or not.
Step 3 Find The Best Lawyer
Who is the best lawyer? Someone with insurance case experience. Someone who has won cases against your insurance company or other similar companies. Someone who can handle your case immediately. And someone who will take your case even if the fee is not guaranteed.
To appeal denial is a complicated process in itself. Just making the initial appeal document will take hours of reviewing and backtracking the communications you’ve had with your insurance company. It will contain the grounds for the case, so it is a very detailed document presenting facts and supporting details of why you think you deserve to get a claim. To make a good case, you also need to have the best lawyer to back you up.
Step 4 Provide All Support throughout The Case Period
Once your appeal is received and reviewed in court, the trial period will then start. You will be busy together with your lawyer. He is the one most knowledgeable how to fight health insurance denial, so heed his word. If he tells you to take health examinations or interviews, do so. It will surely be related to the success of the case.
It is also important that you give as much time as you can for the trial. As the one with the least knowledge, spend time reading through related literature. It will help you understand the trial conversations so you can be more cooperative and attentive. There is more to an appeal for reconsideration than just knowing the health insurance claim denial reasons. It might also help for you to figure out how to appeal insurance claim denial without asking your lawyer yet. This will make it easier for him to explain to you when you have that particular conversation.
Step 5 Finalization
What you do in this step depends on the outcome of the case. Assuming you have won. You will then be contacting your insurance company for the payment. If you are receiving a lump sum, they should be able to hand it out to you within the given period prescribed by the court. If not, you will have to go after them.
After this, you also need to deal with the lawyer who has helped you get benefits from the company who was supposed to deny appeal. It is not an easy feat to do and the corresponding fee depends on how much you receive. Act in good graces and settle all the bills you have with your lawyer. Also, keep his contact information in case you need to chase your insurance company for delayed payments.
The entire process of getting denied by your insurance provider and then filing a case takes a lot of time. It also takes a toll on your emotions. It is advisable that you have someone to lean on in time of weakness because there will always be minor setbacks along the way. Just keep in mind not to be discouraged and give your full trust to your lawyer. He will do his best to win the case. Just give your full cooperation and respond to his communications as soon as possible.
