Health Insurance Claim Denied? Don't Give Up!
Here's Why Appealing Works (And How to Do It Right)
Receiving a health insurance claim denial can feel like a punch in the gut. After navigating the complex world of healthcare, seeing that "denied" stamp on a claim is frustrating and confusing. Many people simply give up, assuming the insurance company has the final say.
But here’s the good news: you have the right to appeal, and appeals have a surprisingly high success rate!
Don't let a denial cost you thousands of dollars. The odds of overturning that decision are often in your favor.
The Shocking Truth About Health Insurance Appeals
You might think fighting a giant insurance company is a lost cause. Think again. Statistics consistently show that a significant percentage of internal appeals are successful.
Studies have found that internal appeals of denied claims have a success rate of anywhere from 40% to over 60%!
That's right. Over half of denied claims are overturned when properly appealed. Why are the numbers so high? Often, denials happen due to simple coding errors, missing information, or a first-level reviewer misinterpreting the medical necessity of your care. These are all correctable issues.
The key takeaway? Most people who appeal win. Yet, less than 1% of denied claims are actually appealed. This means countless individuals are missing out on getting their rightful coverage simply because they don't know the process or are too intimidated to try.
Get Instant Access to Legal Appeal Letter
Why Your Appeal Can Succeed
A successful health insurance appeal isn't just about complaining; it's about providing the right information clearly and concisely. Insurance companies have a process they must follow, and you need to use that process effectively.
Here are three reasons why your appeal has a strong chance:
1. You Have the Law on Your Side
Under the Affordable Care Act (ACA), you have the right to an internal appeal and, if necessary, an external review by an independent third party. Insurers are legally required to review their decisions fairly.
2. Medical Records Can Tell the Full Story
Often, the initial claim didn't fully communicate the medical necessity of your treatment. Submitting detailed records, a "letter of medical necessity" from your doctor, and clinical literature provides the evidence needed to overturn a denial.
3. Errors Happen
Reviewers make mistakes. A well-structured appeal highlights exactly where the error occurred and why your claim should have been paid.
Take Control of Your Healthcare Costs
Fighting a denial can seem daunting, but it is a fight worth having. The success rates are too high to ignore: denials are often overturned when challenged.
Don't let a simple piece of paper cost you your hard-earned money. Empower yourself with the knowledge and tools needed to challenge that denial effectively.
The Shocking Success Rate of Health Insurance Appeals
Insurance companies process billions of claims every year and deny millions. These denials are not always a fair assessment of your claim; sometimes they are automated errors or based on a misinterpretation of your policy.
When you file an internal appeal (the first step), nearly half (around 44%) are successful. If an internal appeal is denied and you take it to an external, third-party review, success rates can be even higher, sometimes over 80%.
These numbers prove that the system expects you to give up. By taking action, you are putting yourself in a powerful position to get the coverage you deserve.
Health Insurance Claim Denied? You're Not Out of Options! (Here's How to Win Your Appeal)
Why Do Appeals Work?
Appeals succeed for several key reasons:
Persistence: The simple act of filing an appeal shows you won't accept the denial without scrutiny.
Detailed Persuasive Appeal Letter: A detailed appeal letter does not miss any arguments about your case and will make sure the appeal specialist reviews all points raised in your appeal.
Documentation: A successful appeal is built on providing comprehensive medical records, notes from your doctor, and relevant policy information that supports your case.
Medical Necessity: Denials often cite that a service wasn't "medically necessary". When patients and their doctors push back with evidence, they succeed approximately 70% of the time in overturning this specific reason.
How to Start Your Appeal Today
The process can seem overwhelming, but it follows a clear path. In my FREE Appeal Guide, I share legal tips on how to submit a winning appeal.
Review Your Explanation of Benefits (EOB): Understand the specific reason for the denial and the timeframe you have to appeal (usually 30 to 180 days). It is important to file your appeal before the deadline.
Gather Your Documentation: Collect all relevant medical records and a letter from your doctor explaining why the treatment was necessary.
Submit a Clear Appeal Letter: Address the specific denial reason, reference your policy language if possible, and include all supporting evidence. Our appeal letters address denials for various reasons and you can choose the one that applies to your situation.
Don't Face Denials Alone: We Can Help
The process requires attention to detail and a professional approach. To help you navigate this system with confidence, we've developed comprehensive, easy-to-use appeal letter templates written by an attorney and specifically designed for denied health insurance claims.
Our DIY templates give you the structure and language proven to be effective in overturning denials. For just $29, you get:
Templates for various denial reasons (e.g., "not medically necessary", prior authorization issues);
Step-by-step video instructions on what information to include;
Guidance on gathering the right supporting documentation.
Taking the Next Step - Learn More in My FREE Appeal Guide
With our our template letters, you control your personal health information and do not share it with us. We prioritize your privacy and do not ask you to share your health information online. We believe you shouldn't have to choose between a strong appeal and your privacy. Our attorney-drafted templates, developed with expert knowledge of the appeals process, guide you to fill in your own information securely in your letter without sharing it online. You maintain complete control over your data, ensuring that your most personal health stories remain confidential while still producing a comprehensive, persuasive, and effective appeal letter.
Our attorney-written appeal letters come with our video tutorials that explain in detail how to use the template, how to fill in your information, where to get more information and documents needed for a successful appeal. You get an attorney-crafted document that speaks the language of insurance appeals, without the risk of AI-generated errors or privacy issues. With our guidance, you empower yourself to effectively advocate for your health coverage, securely and with confidence.
