How to Fight Health Insurance Denials and Win

Understanding Health Insurance Denials

• 💡 More than two out of five working-age adults report being charged for a health service they thought was free or covered.
• ⚠️ Fewer than half of these individuals challenged those bills by contacting their provider or insurer.
• 📌 Many patients are left at a loss about what to do when their insurance company denies care recommended by a doctor.

Your Right to Appeal Denied Care

• ✅ Patients absolutely have the right to challenge denials, even after an initial appeal has been upheld by the insurance company.
• ❓ A significant number of people don't challenge denials because they don't believe they have the right to do so, or they don't know who to contact.
• 🗣️ Speaking up and making things happen is encouraged, as there are tactics you can use to fight a denial.

Steps to Challenge a Denial

• 📞 Contact your insurance provider immediately to understand the steps required to appeal the decision.
• 🏥 Reach out to your healthcare provider to inform them of the denial and ask for advice and supporting documentation.
• 📝 Request that your provider write a letter detailing the medical necessity of the denied treatment.

When to Involve an Attorney

• ⚖️ Attorney Thomas L. Lre suggests that involving a lawyer can be costly, with hourly rates potentially ranging from $400 to $2,500.
• 💸 This expense can be a significant burden for patients already struggling to afford necessary care, adding insult to injury.
• 🤝 Unless a lawyer takes a case pro bono, the cost may outweigh the potential benefit for the patient, especially if the demand letter does not yield results.

Systemic Issues in Healthcare Billing

• 🧩 Patients are often caught in the middle of payment disputes between medical providers and insurance carriers.
• ⚠️ This puts patients in an unfair position, facing challenges related to billing and access to care due to these disputes.