What are my options for appealing an insurer’s decision?
With the health insurance insurance in upheaval over the last couple years, many people do not know what to do if their claim is denied, or if they are dropped from their insurance carrier. While there are no guarantees of success, the good news is that if you have been denied a claim or been dropped from coverage, you have options.
In the event that your insurer is unwilling to pay out your claim, or if you get dropped, you have the right to ask the insurer to reconsider this action. You can also demand to know what the basis is for the company’s decision. Insurers are required by law to tell you why they deny a claim or drop coverage, but you have to request this information. Thtey are likewise required to inform you of the proper channels to go through to dispute their claim denial or coverage cancellation.
Appeals of an insurer’s decisions can be done by either appealing for an internal reconsideration, or, if that is unsuccessful, an external review of your case. If you take your claim to an independent third party for review, the insurer will no longer have the right to make a final determination on your case.
Dealing with insurance companies can feel like an overwhelming battle of David-versus-Goliath proportions, that is lengthy and exhausting. Just because you are an individual trying to get fair treatment from a large company does not mean you should give up. If you are facing a dispute with an insurer, you may want to consider enlisting the representation of an experienced lawyer to help with your fight. A lawyer with experience in disputing insurance decisions will know the ins and outs of the system and the relevant laws, providing you with guidance and additional clout to see to that your claim or dismissal is reconsidered fairly, while your rights remain protected.
Source: healthcare.gov, “How to appeal an insurance company decision,” accessed Sep. 30, 2016