Detailing the appeals process for denied health insurance claims

Posted on: Wednesday, July 13, 2011

While insurance agents work for insurers, it's important for clients to know that agents also work for them, particularly when it comes to filing a claim that's denied by the insurer.

The New York Times recently listed several things clients should know should they want to challenge a claim denial.

The source states the policyholder should have all the paperwork in order, including receipts, summary of benefits and medical records. Once the policyholder gets in touch with the insurance company, the Times says they should write detailed notes, including the length of the phone call, the name of the representative spoken to and what the specifics of the conversation were.

Finally, the Times says the policyholder should write down as compelling a case as they can as to why the claim should be accepted, and if possible, to add their doctor's comments. Physicians may be able to write a letter of medical necessity.

Being aware of the appeals process may improve the client-agent relationship, potentially leading to more insurance leads down the road, as clients may refer them to friends.

Posted In: Insurance News, Health Insurance

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