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Successfully Appealing A Denied Health Insurance Claim

It's one of the most frustrating situations: You receive a bill from your health care provider stating that your insurance claim was denied and you owe a significant amount of money for a procedure you believed was covered by your health insurance plan. With the bill in hand, you know you are in store for a lengthy - and exasperating - appeals process with an insurance company that knows every strategy to avoid paying.

Your first step is to get a knowledgeable professional on your side

Instead of trying to maneuver through this complex system yourself, partner with a civil litigation attorney who is experienced in bad faith insurance claims. These are the legal experts who understand the system and ways to navigate the appeals process efficiently and effectively.

Once you have received the denied claim notice, your next step should be to contact an experienced civil litigation attorney who focuses on bad faith insurance claims. According to, here are the next steps you can expect, as you work through the appeals process:

  • An appeal is prepared by both you and your attorney. As the appeal is prepared, you should expect to provide any and all documentation related to the claim. It is in your best interest to be as organized as possible, and to provide as much information as possible. If you have contacted any insurance company representatives on your own prior to hiring your attorney, then provide your attorney with the names and contact information of these representatives. Once all of the documentation is prepared, the attorney can begin to draft the specific language regarding the grounds for the appeal.
  • The draft is written to be as concise and informative as possible, as this is what insurance company will need in order to process the appeal. For the recipients of claim denials, it often feels personal. In many cases, the denial of the coverage comes as a complete surprise during an already emotional and stressful time. For example, people who are being treated for a chronic illness are often managing their finances while also trying to take care of their physical and emotional health. It is a very natural response to want to plead with the insurance representatives and share your story. Remember, though, your appeal is a business decision; not based on an emotional response.

    Your civil litigation attorney will work with you to create an appeal that will be accepted by the insurance company. Generally, this means the appeal should be written as concisely as possible. The language should be strictly professional and should not include emotional stories of long nights in the hospital room and unpaid utility bills sitting on the kitchen table. Instead, the appeals claim should include the data and facts surrounding the claim, as well as the specific coverage information provided in the health care policy.
  • The attorney will continue to demand that the appeal is granted, working with multiple people at different levels of the insurance company if necessary. Given the complexity of the appeals process, a person working to represent themselves may give up if their first call generates no results. However, an attorney who specializes in bad faith insurance claims understands that there are other people within the insurance company who may provide better results. If the first step of the appeals process is unsuccessful, your attorney will continue to forge on and ask to speak to the underwriter who is above the case worker who answers the phones. Your attorney will not rest, even if it means they have to speak to the person in charge at the insurance company.

Overcoming the insurance company's mistakes

Unfortunately, the insurance companies make mistakes, and they make them all too often. At the same time, they are counting on the fact that most people will not want to deal with the frustration of appealing a denied claim in order to get their benefits covered. By working with a lawyer who specializes in bad faith insurance claims, you can rest assured that you will have the best chance of winning your appeal for the benefits you are entitled to. In the event bad faith can be proven, there may also be an opportunity to win additional damages, including attorneys' fees. With a legal professional on your side, you will have the guidance you need to navigate through this complex process and receive the compensation you deserve.

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