What Do You Do If Your Insurance Company Refuses to Pay a Medical Bill?


Quick Answer

If an insurance company refuses to pay a medical bill, the affected consumer should read his policy with an eye toward analyzing the legitimacy of the denial, his rights and responsibilities, and the process for appealing the denial, explains the National Association of Insurance Commissioners. The next step is to contact the insurance company about the denial and, if the situation remains unresolved, be tenacious.

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Full Answer

A consumer needs to ask the insurance company for a written explanation of why the claim was denied, and after he receives it, to examine his policy to determine if the denial is justified, according to About.com. If it is not justified, the next step is to clarify why. For example, if the denial reason is a coverage reduction, the consumer should confirm notification of the reduction. Enlisting the support of the doctor who performed the procedure may be necessary in getting the claims denial overturned.

Contacting the person who issued the denial is often an early step and sometimes brings to light an error the person made, explains About.com. If that does not work, following up with a written appeal is common. State insurance departments, professional arbitrators and lawyers can meditate and help in other ways. When appealing a claims denial, it's critical to fill out forms correctly and to meet all deadlines. Consumers should record all contacts they have with the insurance company, such as who they spoke to, when and at what time, and the dates they sent letters or completed a step in the claims denial appeal.

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