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How to appeal a health insurance claim

If your health insurer has denied coverage for medical care you received, you have the right to appeal the claim, and ask that the company reverse that decision. You can be your own health care advocate.

Below are some five steps you can follow when appealing for a health insurance claim

  • Review your policy and explanation of benefits.
  • Contact your insurer and keep detailed records of your contacts (copies of letters, time and date of conversations).
  • Request documentation from your doctor or employer to support your case.
  • Write a formal complaint letter explaining what care was denied and why you are appealing through use of the company's internal review process.
  • If the internal appeal is not granted through step four, file a claim with your state's insurance department.

Benefits of health insurance

Even healthy people need health insurance. Having a health plan helps maintain and may even improve the health and wellness of you and your family. And it may help in the event of an accident or illness. You never know when an illness or accident might happen. That's why, under the health reform law, almost everyone needs to have health insurance, or pay a penalty.

  • When you have health insurance, your plan may pay some of your medical costs. Plus you're encouraged to seek routine preventive care which may help you avoid developing an illness or health condition, or find it at an earlier stage when it's often more treatable.
  • Health insurance costs money but not having it could cost a lot more. Unforeseen medical needs, combined with high health care costs, could leave you with medical bills if you're not insured. Having health insurance coverage can help reduce unexpected medical costs.
  • It’s hard to know how much you'll spend on health care each year. But having health insurance helps pay for sudden, expensive medical costs. It also helps you pay for common services like annual check-ups, recommended health screenings and preventive care services.
  • Prevention: Having a health insurance is the ability to prevent diseases through early detection and doctor recommended lifestyle changes. This prevention not only keeps citizens healthier, but it also saves money on the expense of the health care that would otherwise be required to deal with the problem when it arises.
  • Peace of mind: Having health insurance leads to peace of mind for those who have it. If a nagging problem such as an unusual pain persists in someone with health insurance they can go to the doctor without significant out of pocket expense and get it checked out even if it leads to diagnostic testing.
  • Health care costs are low when the member stays within the provided network. This plan allows more freedom than HMOs in many ways. The member is not required to choose a primary care physician and can see a specialist without a referral, including the specialists that are outside the network. If care is sought outside the network the costs are more expensive and all the paperwork can be individual’s responsibility.

Compare Rates

Our website allows clients to be able to compare insurance rates from different insurers. We normally ask for information that includes some basic information about you, your vehicle, your driving record, and limited information about any other drivers you’d like to insure on your policy.Our website provides you with actual prices from different insurers and not estimates like some websites. These different prices will assist you decide which one is the most friendly for you. With this comparison service we help you save both time and money through finding all the information you require in one place.


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