Don’t Be Afraid to Appeal Your Insurance Claim Denial

Healthcare insurance companies deny A LOT of claims. In 2021 alone, there were 48 million denials of insurance claims. And those were just the in-network claims.

Here are some more interesting statistics:

• Of those 48 million claims, only a little over 90,000 claims were appealed

• 90,000 seems like a lot. But that’s only 0.2% of the denied claims

• The insurance companies granted the appeal in 40% of the cases

According to Money magazine and the American Hospital association, those claim denials increased dramatically in 2022 and 2023.

Many times insurance companies deny claims simply because someone made a mistake on the paperwork.

Can you imagine having to pay your medical bills out of pocket just because someone screwed up your paperwork? That could potentially be $ thousands for a simple error.

Sheesh!

Think how lucrative claim denials are for insurance companies. They can deny 48 million claims or more each year.

Have only a 0.2% rate of appeal.

And then only approve 4 in 10 of those 0.2% appeals.

That’s great for business!

Are you starting to see why I’m so enthusiastic about appealing claims to get back at these companies?

I deal with insurance companies for Medicaid claims at some of my homes. When I have a claim denied, I take it as a personal challenge. I am relentless in fighting them because I consider it as insurance companies stealing from me.

If you don’t pay the insurance company their premium, they will drop you like a hot potato. Be as relentless as they are!

Let’s say you were denied a claim for a health issue. Of course I’m assuming your claim is legitimate. Don’t laugh. A lot of people submit claims for stuff that really is not covered by insurance. Nor should it be.

How do you appeal it?

You can go to healthcare.gov for information. They talk about internal and external appeals.

It might be challenging to do this. Especially if you’re dealing with a serious health issue. That’s why it’s so important to have a support network. Family and friends can help you with the appeal.

If you’re in a large medical facility, there are employees that can help you with your appeal. Start with the doctors and nurses to ask what they can do. Also talk to the social worker assigned to your case.

Ask for a ‘patient advocate’ if you aren’t receiving the help you need.

Here’s a great website that uses AI to help you craft your appeal documentation.

If you appeal and still receive a denial, try this:

I do not have personal experience doing this. However, it sounds like a great way to have an appeal granted. Fight bureaucracy with bureaucracy!

Of course the best way to avoid a claim denial is to take care of your own health. Reduce the amount of claims you need to make.

When you do need to make a claim, however, fight for your rights as much as possible. Don’t let the big corporations win.