In order to successfully appeal a health insurance company’s denial it is first important to understand why your claim was denied. Your insurance company should have listed the reason for denying you your settlement on your denial letter. Typically, an insurance company will deny a health insurance claim for one of the following reasons:

• Incorrect Patient Identifier Information: If important information such as your name, social security number, or date of birth is wrong, the insurance company cannot identify you as the patient, and therefore, cannot pay you.
• Terminated Coverage: Oftentimes, policyholders will let their insurance coverage lapse without even realizing it. If your claim has been denied, double check to make sure that you are current on all payments.
• Services Are Excluded: Another common reason for denial is simply because your insurance policy does not cover the services or treatment you filed for.
• Request For Medical Records: Sometimes an insurance company won’t deny you your claim; they’ll simply send a request for more information. Oftentimes, the health insurance provider wants to see a proof of your treatment and condition, so they will request a copy of your medical records.
• Bill Liability Carrier: Sometimes a health insurance company will refuse to pay out your claim because they believe that a different carrier should handle it. For instance, if you were injured at work but filed a health insurance claim with your health insurance provider, they may request that you go through your employer’s workers’ compensation provider.
• Missing or Invalid Codes: If your medical coder is not up-to-date on the most recent changes to the health care coding system, they may unwittingly mess up your claim.