How to Get Your Health Care Denial Overturned, Step-by-Step:

ProPublica’s health insurance claim filing tool makes appealing health care denials from insurance much easier. With health care denials as high as 30% from some insurance companies, and often based on algorithms, not on review by clinicians, being able to advocate for yourself is crucial. Note: I am not a lawyer. Instead, I am a social worker whose job it has been for the last three decades to advocate for others and teach others to advocate for themselves. This article is not legal advice. It simply consolidates several useful tools for dealing with health care denials.

Click here to find the health care denial tool:

Some key points for using the tool:

• This is step one of a multi step process. Appealing will take time, energy, and persistence.
• You will need the physical address of your insurance company. The denial tool page gives a list of some common addresses as well as advice as to how to look up other addresses. Be sure to follow the instructions.
• Insurance companies depend on you not having the energy or know-how to follow through to get health care denials overturned. Be sure to challenge every claim denial
• To make it easier on yourself, before starting your claim denial, make sure you have postage stamps and envelopes already handy. If you don’t have a printer at home, you might use your local public library, your work computer, or a copy store to print out the form. If necessary, you can even copy the information by hand.
• Take pictures of all of the documents. This includes the letter the health care denial tool helps you format and the health care denials you have received.
• Store the pictures in multiple places for safety (for instance, on your phone, and then email them to yourself).
• Mail or fax your request for the information you need for your appeal. ProPublica suggests you use certified mail.

Once you get your health insurance claim file back, it should give you the information you need to craft an appeal:

• Fortunately, there are a lot of places online that will help you craft an appeal letter.
• Again, see the ProPublica health claim denial tool for physical addresses or how to find them.
• This link to the Patient Advocate Foundation has a handy list of what to include in your appeal. You will include the information you gathered through the appeal tool.
• Solace provides more information about filing your claim that you might find useful.
• At the bottom of the Patient Advocate Foundation’s page on how to file, they have provided links to several sample letters. One is for appealing a denial. The other is for appealing a denied pre-authorization.
• Again, take pictures of all the information you send in, and save them in several safe locations.
• Mail or fax your request. Again, ProPublica suggests you use certified mail.

What to do if your claim is still denied:

At this point, it’s time to go to your state insurance commissioner. Fortunately, Forbes Magazine has created an article (not behind a paywall) that lists phone numbers and links to addresses for all 50 states.

• Include in writing all of the information you sent in the first and second parts (the reason for the appeal and the denial of the appeal).
• Take pictures (again) of the documents you are submitting, and store them in more than one safe place.
• Mail or fax your request to the address given for consumer complaints in your state. (See above or click this link).

ProPublica is a non-profit newsroom. If you want to thank them for their work on the tool that made this article possible, please click here to donate.

Thank you.

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