Steps to Consider When Filing a Health Insurance Appeal

If you’ve recently undergone a medical procedure or need medical treatment, the last thing you want to do is worry about paying out of pocket, especially when you have health insurance coverage.

Unfortunately, insurance companies do not take into consideration the well-being, health, or happiness of those whose claims they deny. Instead, their only goal is to maximize profits by finding any reason to deny a claim that comes their way.

If your health insurance claim was recently denied, it’s important that you understand your options when it comes to filing an appeal. Below, we discuss a few key steps that are involved in the appeals process for a denied health insurance claim.

Internal Review

If you or your insurance claim attorney believe that your insurance claim was denied unfairly or the insurance company engaged in bad faith insurance practices, the first step will be to file for an internal review directly with the health insurance provider. To do so, you simply need to ask the insurance company to conduct a full and fair assessment of your case in order to determine if the decision to deny your claim should be overturned.

An internal review can take anywhere from 30 to 60 days to complete, at which time the insurance company will have to deliver a written decision regarding your claim.

Independent External Review

If the insurance company will not conduct an internal review or if they still deny your claim following an internal review, you will submit an appeal to an independent third party. Independent external reviews are conducted by someone who is independent from your insurance company and is certified by the Oklahoma Insurance Department (OID).

During this stage of the process, it is recommended that you have an attorney at your side who can help you fill out, complete, and submit all necessary paperwork in a timely manner.

Filing a Lawsuit

If, after both of the steps above, you believe that your health insurance claim was still denied unfairly, the next step would be to file a lawsuit against your insurance company. While no one wants to go to court, it may be a necessary step in order to ensure that you receive the compensation needed to cover your medical expenses.

Get Help After a Health Insurance Claim Denial

Having health insurance should bring you peace of mind, not worry about whether the insurance company will unfairly deny your insurance claim. At Aizenman Law Group, our Tulsa insurance claim attorneys have extensive experience in helping our clients obtain a reversal of a health insurance claim denial.

We will do everything in our power to ensure the insurance company provides fair coverage for your medical expenses while you focus on getting healthy.

Contact our firm at 631-769-8431 to get started with your free case review today.