How to Appeal a Denied Medical Claim?

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How to Appeal a Denied Medical Claim?

• Since the COVID-19 pandemic began, the number of
  health insurance claim denials in the US has
  risen by 11. Even with denied medical claims
  more common than ever, surprisingly few of them
  are resubmitted or appealed.
• Tempted to pay the bill for your denied medical
  claim rather than take on the appeal process?
  Save yourself the money and keep reading to learn
  how to correctly appeal a denied claim.
• Why You Should Appeal a Denied Claim
• To appeal a denied claim means to spend precious
  time and effort on the appeal process, even
  without the guarantee of a successful outcome.
  Here are a few reasons why you should still try
  to appeal insurance denials
• You May Win. While the figures vary, some
  speculate that you have about a 60 chance of
  winning a denied medical claim appealif the
  appeal is filed correctly, that is. With the help
  of a service like aJust, you can rest assured
  that your appeal is set up for success. Even if
  your first appeal doesnt get you the desired
  outcome, you have the right to a further appeal
  through your health insurance company or an
  external review service.

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• Extra Time. Appealing a denied claim buys you
  extra time before you need to pay your medical
  bill. While you wait for your insurance companys
  decision, you can work on establishing a plan B
  to afford your medical bills.
• Continuation of Treatment. If you receive a
  denial for a service that youll need again (such
  as the first of many prescribed physical therapy
  sessions), that one denied medical
• claim can suddenly disrupt your treatment. In
  that case, an appeal is crucial, as the denied
• medical claim has implications for the future,
  not only the present.
• What the Appeal Process Looks Like
• While the health insurance appeal process varies
  depending on your insurance company and
  individual plan, here is what you can expect
• First, youll learn of the medical claim denial,
  either through an Explanation of Benefits letter
  from your health insurance company or a bill from
  the medical facility.
• Next, youll have to reach out to your insurance
  company by phone, mail, or online through a
  portal or app. From there, youll file an
  official appeal with the help of a customer
  service agent.
• Its time to hurry up and wait! Appeal decisions
  can take months to come through. Either your
  health insurance will reverse their decision and
  pay for the service (minus your copay or
  deductible if applicable), or theyll stick by
  their original decision.
• Some health insurance plans allow you to try for
  a second appeal. The process may differ from the
  first appeal or require a letter from your
  doctor. You may be required to submit an appeal
  letter as wellmore about that later!
• If you still arent successful, you can then file
  an external appeal. This will be processed by an
  independent organization that handles such
  matters, or by your local government.

• Dont fight a denied medical claim alonereach
  out to aJust today!
• Tips for Writing an Appeal Letter
• Many health insurance plans require that you
  submit an appeal letter with your denied claim
  appeal. Keep these tips in mind when writing your
  appeal letter
• Follow Directions. In order to avoid losing your
  shot at an appeal due to an oversight, follow all
  directions your insurance company provides. This
  may mean including specific information or
  formatting your letter a certain way.

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• Include Important Information. In your appeal
  letter, youll want to include information like
  your name, birthdate, and member ID number, along
  with the date of the denial and the contact
  information of the doctor who provided the
  service.
• Be Convincing. This is your chance to convince
  the health insurance company why they should
  appeal the denied medical claim. Remember that
  the goal of your insurance company is to save
  their business money. With that in mind, explain
  how receiving this denied treatment will help you
  avoid racking up further health costs in the
  future. Articulate why you believed this service
  would be covered and how you think it fits into
  your health insurance plan.
• Provide Supporting Documents. Once youve written
  a winning appeal letter, include all the
  supporting documents you have. This could include
  a letter from a medical professional, test
  results, and any paperwork you received about
  your medical claim denial.
• Get Help from a Professional. Does all of this
  sound like a job for an expert, not you the
  patient? Thats because it should be! Even
  medical professionals feel overwhelmed with the
  insurance appeal process, which is
  counterintuitive and time-consuming. So get help
  from a professional, like aJust, and take
  uncertainty out of the equation.
• How to Get Started
• Ready to get help appealing an insurance denial?
  Once youve gathered your documents, fill out
  this two-minute form to learn how aJust can help.
  Instead of spending hours on hold with the
  insurance company, you can dedicate your time to
  the responsibilities and joys of daily life while
  aJust takes care of your denied medical claim.