When Your Claim is Denied
Once in a while, when you have a test or treatment that isn't covered, or you get a prescription filled, your insurance company won't pay the bill. You can still get the treatment your doctor recommended, but you will have to pay for it yourself.
If your insurance company denies your claim, you have the right to appeal the decision. Before you start, become familiar with your insurance company's appeal process. This should be discussed in your plan handbook. Also, ask your doctor for his or her opinion as he or she may be able to help you through the process.
Be sure to document your appeal thoroughly. Sometimes claims are denied because of an improper billing or miscommunication. During the appeal process, your appeal and the original denial will be reviewed. You want your appeal to be the more believable of the two.
Most insurance companies allow two levels of appeal, and most states have set appeal requirements and standards.