How Do You Fight an Insurance Claim?

We all need to have health insurance to protect ourselves financially from the burdens of hospital bills and many other expenses. Millions of people often rely on health insurance to help them with these issues but what happens when they deny your claim especially when it is necessary for your health?

There are many ways for you to appeal any rejected health insurance claim and it is still possible to get the coverage that you need. A lot of insurance companies can be difficult to work with but if you how to appeal for your denied health insurance claim, you will certainly be able to reclaim what is rightfully yours.


If you want to learn more about how insurance claims work and how you can fight against an insurance claim, check out the guide below.

Image Source: JobStreet

How to Appeal an Insurance Claim

If your health insurance provider has refused to pay for your medical bills or even end your health coverage, you always have the right to appeal the decision and have it reviewed.

Image Source: BPI AIA

You can simply ask the health insurer to provide you with all the related pieces of evidence that have provided them with the decision to deny you your claim. They would also need to provide you with the clause that you are free to dispute their decisions at any time.


There are two ways for you to appeal which can be internal appeals or you approach your health insurance provider to review their decision or external review where you get a third party to review the decisions made by the provider.

Both appeals will lead to a thorough investigation of the decision and if the case is important, the provider should have your case expedited.

Sending an Appeals Letter

The very first thing you must do is draft an appeals letter that you send to the health insurance provider. A patient's claim can be appealed by sending a letter that details all the facts surrounding your concern.


Make sure that you provide accurate information as well as any documents that can support your claim. The letter will then be reviewed by a nurse or physician before a decision is made.

This will take some time before a decision is made so make sure that you allot time to wait for the results to come in.

Take All the Necessary Options

As mentioned above, there are two ways for you to appeal your health insurance claim.

Image Source: Insurance Business America

It is always possible that if you have done an internal appeal and they still deny it, you can proceed to have an external review by an approved independent review organization.

You don't have to rely on the decision of the health insurance provider to stop your claim. Make sure that you exhaust all of your efforts in getting the results that you need.

Review the Policy

One important aspect in helping you with your health insurance claim is to review the policy. Check the documents that you have signed and make sure that they provide what is covered in your health insurance policy.

It must also have limitations or exclusions which are the items that your insurance provider does not cover. Read the letter that contains the decision from your provider and compare them with the documents that you have signed to see if there are any discrepancies with their decision against their policy.

If there is one, you should always ask for an appeal and fight for your insurance claim. This will help start the process and provide you with the results that you need.

Call Your Insurance Provider

The next step in fighting for your insurance claim is to call your insurance provider.

Image Source: SelectHealth

If you have questions regarding your claim and why it was denied, they are the best people to talk to so that they can explain to you further why it has happened.

Be sure that you ask why the claim was denied and inquire about the entire process. Ask them why there weren't any considerations made for your claim.

Document the name of the representative that you talked to as well as the date and time you made the call.

Call Your Doctor

You should also call your doctor's office and ask for clarification as the error could also be on their part. Your doctor's office might have entered the wrong code and asked them to fix this error and send them over to your insurance provider.

If you have already been receiving the same treatment and were suddenly denied by your health insurance provider, ask your doctor to send a letter to the provider explaining why you need the treatment.

Additionally, request a duplicate of that letter in your files so that you can have it as evidence when they review your appeal.

Be Familiar With the Appeals Process

In submitting an appeal, you should always be familiar with the entire process. Understand your provider's policies and the appeals process before you even make a move.

This will enable you to spend less money and time preparing all the documents needed for the review. Always keep current information regarding the process, especially with the ones that you're working with.

All the information can be found on your provider's website but you can always ask for proper documentation.

Keep It In a Timely Manner

Lastly, when fighting for your health insurance claim, ensure that you do itas soon as possible. Do not delay any chance of filing for a review or appeal.

Work on the case immediately. It is very important that you submit and resubmit your claims within the timeframe allotted by the provider especially if this is important to your health.

If not, the company will simply provide their decision and you are left without any reconsideration of your claim.

Also Read: How long does an insurance company have to settle a claim?


Regardless of whether a person has health insurance, it can be a challenging time when you're denied your claim. Always make sure that you know your rights when taking action in fighting for your health insurance claim. Hopefully, the information above can help you to effectively appeal for a health insurance claim and get the results that you need.

No posts to display