How to Deal with a Denied Health Insurance Claim

By Krista DeKuyper | March 25, 2022 | Health Insurance

If your health insurance claim is denied, it can be a frustrating and confusing experience. But don’t worry, you’re not alone. Millions of Canadians have their claims denied each year. The good news is that there are things you can do to make the process easier. We’ll walk you through the steps of what you should do and how to deal with a denied health insurance claim.

Why Do Claims Get Denied?

There are different reasons why a health insurance provider might deny payment for a service. Sometimes the reason is simple and easy to fix, and other times it’s harder. Below are some of the reasons we’ve seen for health claims being denied?

  1. Paperwork errors or mix-ups. This could happen if your doctor wrote your name as Smith, T, but your insurer has you listed as Smith, R.
  2. Doubts about medically necessary. Sometimes your insurance broker believes the procedure you had isn’t necessary. It’s up to you to convince them that it is.
  3. Cost control. Other times, insurance providers want you to try another more cost-effective option.

Now let’s go into what to do if you get a denied claim

Take A Breath

The first thing you’ll want to do is take a breath and stay calm. Don’t jump to conclusions yet. You’ll want to remain calm throughout the entire process.

Review Your Insurance Policy

Start immediately after receiving the bill or denial. See if it indeed covers the denied benefit. See what other information you need to provide or if it was just a paperwork error. This is where being organized comes into play. Gather everything you need before you start the appeals process. This will make it go much smoother.

Fill out the insurance company’s appeal process

The next thing you’ll want to do is get info on how your insurance company deals with a denied claim. What documents do you need, what’s the process like what’s the deadline for appeals etc.

Get in touch with customer service

You might also want to try speaking with a customer service representative. Have your policy number ready, refer to the appropriate section of your policy, and state why your claim should have been approved.

What If My Claim Doesn’t Get Approved?

If you go through the appeal process and your issue still isn’t resolved, the next step would be to file a written complaint and appeal to a higher authority and seek legal advice. Oftentimes, legal action is the only way to get the health insurance company to pay a denied claim. Remember to stay calm and organized throughout this process.

Does HealthQuotes Help With Denied Claims?

We suggest all our customers to look at their insurance carrier and understand what the appeal process looks like for you. HealthQuotes doesn’t get involved with individual claims. We can help you find the right insurance policy for your needs and budget, but when it comes to an individual claim, that’s between you and your insurance company.

We hope this article was helpful in understanding how to deal with a denied health insurance claim. If you’re ever unsure about anything or need help deciding which insurance policy is best for you use our instant quoting tool or get in contact with our offices!