As if you needed another medical malady, high blood pressure results from the high anxiety generated when you submit a claim to the insurance company for an expensive procedure, or any procedure for that matter, only to find you've been denied coverage you thought you had.

There is good news! Due to the recently passed Patient Protection and Affordable Care Act, a required report was conducted by the General Accounting Office. This report found that in the four states they researched, 39% to 59% of claim denials were reversed. A similar study performed at the national level conducted by a trade association for insurance companies found that claims were reversed an average of 40% when resubmitted. The Affordable Act is to protect people from claim denial; however, until it is fully implemented, rejections will continue.

Why Are Insurance Claims Being Denied?

Sometimes a claim is denied due to a pre-existing condition. I had back surgery over 30 years ago and it is considered a pre-existing condition, which is outrageous to me.

Ironically, the above report found that m ost claims weren't being denied due to a pre-existing condition nor on subjective matters. Rather, claims were being denied due to billing errors. What were those billing errors? Duplicate billings, for one; perhaps health care providers are a little anxious themselves to be paid. Another form of billing error occurs when information in incomplete. Both situations can be easily remedied.

How Do I Appeal A Claim?

There are a few things you can do. You can:

  • File an appeal of denial with your insurer
  • File a complaint with your state: usually, the Department of Insurance has jurisdiction
  • File a complaint with the US Labor Department for a claim denial from group insurance at work


Available Insurance Help

Should you need help in dealing with your insurance company, or if you need help because you've been denied a claim due to a pre-existing condition, or are having difficulty finding health insurance due to a pre-existing condition, click on the links.

What are some of your claims that have been denied that you thought were covered under your plan? Let me hear from you.