If you insurance claim is denied and you are well aware that you were just served a raw deal, then you have every right to appeal. There are a couple of reasons why the company might reject your claim though such as:
- You might have given them incorrect information at some stage which might affect your claim
- You failed to answer all of the questions on the applications clearly
- You failed to disclose a pre-existing medical condition or a criminal conviction
- You displayed a lack of due care.
However, if none of these apply to you and the insurance company still refuses to cooperate, you have every right to take them to court and appeal. If a phone call doesn’t work, don’t worry. Many insurance company reps are trained to deny coverage on the initial submission in the hopes that you will end up paying.
In other words, they will do everything they can to not pay and if you play along with their denial, you will be the one who will end up paying, a lot! The appeals process is not as complex as they make it out to be either and an experienced attorney can help you through it easily. Like Attorney Javier Marcos.
So if you do decide to take your appeal to court, do so immediately. Once they are presented with this, the insurance company will probably place a time limit of 30 to 40 days on starting the process. Make things easier for yourself by asking them for a written denial via email (so you will have a record) explaining why the insurance claim is denied. This will help you and your attorney in creating a rebuttal that can work in your favor.
Preparing the appeal
The first thing you need to do is to create an argument for your appeal and why it should be taken seriously. However, make sure you have read your policy thoroughly beforehand to ensure you do not appeal something that you already signed up for. Your insurance provider will pounce on this opportunity making it impossible for you to get the damages you need.
At this stage, ask your doctor to help you writing the appeal letter so that the denied claims can be resolved quickly and accurately. For example, if your insurer denies payment for say an MRI even though it is covered in your policy, read the language used in that portion of the policy and ask your doctor to do so as well. The billing department of the hospital or clinic where you got the procedure done may be able to change the bill accordingly.
Insurance claim is denied? Call Attorney Javier Marcos
If your insurance claim is denied under questionable grounds and you have been handed a massive medical bill to pay yourself, Attorney Javier Marcos can help. We can provide you an attorney who will appeal your case in court and aid you in understanding the process as well. Just give us a call by dialing 713.999.444 and we will set up a FREE consultation for you.