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3 Simple Things to Do about a Denied Claim

Julia Peterson | May 4, 2018

denied claim

“Your claim has been denied.” Now what?

It’s not a fun phrase to hear, and your instinct may be to ask for a supervisor and face off in a verbal joust. Instead of spending an hour on the phone, consider these three easy things you can do about your denied claim.

First, recognize that your claim may not be denied permanently.

The word “denied” can be in different ways. These can be referred to as a “soft” denial and a “hard” denial. A soft denial occurs when the claim is denied because more information is needed. This could be medical records, your receipt, a bill, or a claim form. This denial is no reason to panic. It can usually be resolved with an email or a call to your doctor’s office. A hard denial is different. This is when your claim was denied because the service wasn’t covered. If your claim was denied permanently, there’s something else you can do: file an appeal.

Second, file an appeal.

Appeals sound difficult, but it can actually be easier than filing the claim itself. An appeal is an official way to dispute the decision that was made on your claim. You can do this when you have supporting documents showing why you believe the decision was incorrect. Be sure you understand exactly why your claim was denied. This way, you don’t spend time explaining something the insurance company already knows. Write a letter about your claim, and include the documents to support it.

Submit your appeal, and then sit back and relax. You’ve done what you can. It takes some time to review an appeal, so ask the insurance company about that timeframe. Once it has passed, follow-up and find out whether the claim was approved.

Finally, the last thing you can do is learn from the experience.

If the worst-case scenario happens and your claim is denied again, it may be time to step back. Most things are learned by experience, and now you have that experience for the future. You may be more aware now of the benefits your plan has, or you may know what to look for in an insurance plan in the future. Denied claims are often not fun, but they do offer a lot of wisdom for the future.

Have a question about your denied claim, or how to file an appeal? Visit our website to find helpful tips, or contact us anytime.

About the Author

Julia Peterson

Julia Peterson joined the Seven Corners Customer Service team in February 2016. She is known as a writer and photographer, an extrovert, and master of the Rubik’s cube. She works from home in Michigan where she lives with her husband and her orange, half-blind cat, Murphy.