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How To Appeal A Denied Health Insurance Claim
A general walk-through of the stages of challenging a health insurance denial, from checking for errors to internal review, outside review and complaints.
Enrolling And Switching
Appeals And Disputes
What to do when a claim or request is denied.
Common Reasons Claims Are Denied
An overview of the administrative and medical reasons health insurance claims are typically denied, and which ones are often simple to fix.
Complaints To Regulators And Ombudsman Offices
A general look at complaint channels outside the insurer, including regulators and ombudsman offices, what they can and cannot do, and how to prepare.
How To Read A Denial Letter
A guide to the usual parts of a health insurance denial notice, what each section tends to say, and what to look for before deciding how to respond.
Internal Review Versus External Review
Compare asking the insurer to reconsider a denial with asking an independent organization to decide, including who reviews, when each applies and typical limits.
Keeping Records For A Health Insurance Dispute
What to save, how to log phone calls, and how to organize paperwork so a health insurance dispute or appeal is easier to support and follow up.
Medical Necessity Explained
How health plans typically define medical necessity, how they apply it to coverage decisions, and what that can mean when a service is denied.
Step Therapy And Why Plans Require It
Why some health plans ask patients to try one treatment before another, how step therapy typically works, and what exceptions or appeals may exist.
Understanding Prior Authorization
What prior authorization is, why health plans use it, how requests are reviewed, why delays happen, and general steps to take if approval is slow or denied.
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