When a health care claim is denied, the inclination is to gripe and complain, blame the insurance company and forget it. Not good
Consumers rarely appeal denied claims. In 2017, for example, the data show consumers filed appeals on about 200,000 of more than 42 million denied claims. On average, appeals resulted in a reversal of the initial denial in 14 percent of cases, though with wide variations among individual insurers, which had reversal rates ranging from 1 percent to 88 percent. Source: KFF Report
The fact is many denials are administrative in nature and can be fixed. Sometimes the claim has been coded incorrectly by the health care provider. Other times it is denied for medical necessity; a cause of much controversy and generally blamed on the insurance company – often unfairly. Sometimes, it’s just a screwup by a claim processor.
But no matter what the reason for the denial… appeal any denial.
If you are covered by your employer plan, there will be a detailed claim appeal process to follow-with time limits.
Don’t delay appealing. ‼️ Always‼️