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What To Do When Insurance Claims are Rejected

When your claim is rejected, you have recourse and can file an appeal.

Most insurers have a fair and fact-based approach to handling insurance claims. Claims are rejected, however, so if it happens to you, don’t panic. You do have recourse. Here are some easy steps to take when dealing with a rejected insurance claim.

START BY ASKING QUESTIONS

Ask your insurer for an Explanation of Benefits with your claim. Study your EOB as well as the booklet on the appeals process, which should be included. If there's anything you believe isn't in there, call your insurer for clarification. Always ask for specifics regarding why your claim was rejected. It could be as simple as a typo, wrong date, or misunderstanding.

GATHER THE NECESSARY INTEL

If a clerical error is to blame, that's simple enough to fix. Make sure to send your insurer all the necessary paperwork and double check the information, including times and dates.

Beyond a typo, you will need to make an argument for your case in writing. In medical situations, a doctor can write a letter to persuade your insurer that a medical procedure is necessary. Provide well-sourced news articles and academic research to support the procedure. Build as strong a case as you can before you start pushing through the appeals process.

APPEAL, AND BE PATIENT (IF THAT'S AN OPTION)

In most cases, you have 180 days to file your appeal from the rejection date, and, from there, you can expect the appeal review to take from 30 to 60 days. You might qualify for an urgent appeal review, which will take 72 hours or less, but this is only for extreme circumstances. If you file for an external review, that can add another 45 days to the process, (or, again, 72 hours for urgent reviews, depending on circumstances).

If your concerns are not life-threatening or otherwise dire, then you're probably going to have to wait at least a month before you have a decision.

From here, you might be denied again, and, in some circumstances, taking legal action might prove necessary. Most insurance companies are not looking to cheat or deny necessary insurance claims. The insurance agents in Corpus Christi provide a small-town touch in this growing community by working with you one on one to submit claims. Contact any of the insurance agents in the Corpus Christi Insurance Guide for insurance quotes and information on how to file a claim and be prepared to appeal in case of rejection.

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