Is There Recourse For a Denied Insurance Claim?

Have you had a denied insurance claim? Your Insurance Attorney in Miami Dade can help. We understand the process to appeal a decision and we can help you get the results that you were denied the first time around. Insurance companies can make mistakes and some can even willfully deny your benefits, but we make sure that they do what they are supposed to. If you interested in learning more about what we do, contact the insurance claim lawyer at Your Insurance Attorney today.


The First Steps After a Denied Insurance Claim


The first thing that you need to do after your insurance claim is denied is to look at your explanation of benefits. This is a form that is sent by the insurance company whether or not your claim was approved to detail the explanation as to why your claim has arrived at its decision. Usually, these EOBs will use codes, but the insurance company will also list a key to the codes so that you can understand what they mean. If the EOB still isn’t clear as to why your claim was denied, you have the right to call your insurance company and ask them. They are responsible for explaining it to you in a way that you understand.


The next step after you have checked your EOB is to see what problems you can rectify easily. For instance, if the denial was due to a data-entry error–such as a misspelled name or insurance ID number–you can contact the insurance company to correct the errors. If the error was on the part of your medical provider, ask them to take care of the problem and then resubmit the claim.


If it is not due to an error, the next step is to gather all the evidence that you need. You need to prove that your claim was for services that were medically necessary. Be sure to pull all the records, exams, and referrals that will help to prove your case. Once you have done this, you can then submit an appeal to your insurance company. This process should be readily available on their website, but you may also call them to see how it works.


What Happens When the Insurance Company Won’t Listen


Many people often find themselves calling their insurance company to understand why their claim is being denied. Because having a claim denied can be so scary, they turn to the customer service representative to as the outlet for their frustration, but this is a mistake. Typically, the person that you speak to on the phone with the insurance company is not the person that is responsible for your claim and the last thing you want is to direct your anger at someone who does not deserve it.


The best way to remedy this is to target the insurance company directly. With an insurance claim lawyer, you can take on the company itself for your denied claim and get much better results than you would otherwise.


Need an Insurance Claim Lawyer? Contact Us


Your Insurance Attorney in Miami Dade can help you deal with a denied insurance claim. To learn more about how we can help you, contact us today.

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