What if Your Medical Insurance Claim is Rejected?

Since insurance companies main goal is to maximize profits and minimize costs wherever possible, they systematically deny or pay the medical claims submitted to them. Most people just give up rather than fight against the insurance company, but you may be able to get the decision overturned by following a few simple steps.

First, the initial rejection of your application may not be personal. Insurers may have sent you a form letter sent to all candidates seeking reimbursement for a particular procedure or substance, they determined, will be rejected. When this happens, you get a confirmation from your doctor that the procedure or drugs you need is medically necessary and essential to your health rather than beneficial. Ask your doctor to write a letter to the medical necessity of treatment or drug for you to submit to the insurer.

You can also do some research on the Internet to find out if a drug or procedure, the doctor wants you to have the following basic guidelines adopted by major medical organizations like the American Heart Association. For example, the site of the doctor, someone could write a "fixed rules" in the search field to find out what are the guidelines set by doctors to treat his illness.

If you ask your doctor or the Internet that the procedure or drug is medically necessary to have a previous complaint with the insurance company by sending them a letter stating that you are using the word "appeal". Send all documentation to the letter and addressed in a letter, keep a copy of the letter and your original documents. Insurers are required by law to process your complaint in time.

If the insurance through the employer sends a copy of the application to the responsible head of human resources or health benefits administrator. If they are looking for their employees than they should, they burden the original decision to cancel the insurance.

What happens next? Statistically, if your appeal is heard by a panel of outside reviewers, there is slightly over a 50% chance the decision will be reversed & the drug or procedure in query will be covered.

Don't be afraid to contact the reviewers handling your appeal. A reviewer ight be a nurse or medical director or other one that works in the healthcare industry.