When you hear that your claim has been denied, your first instinct may be to panic. It’s not a fun place to be! However, if you feel your claim needs to be reviewed again for coverage, there are steps you can take to make sure that the insurance company knows everything you know.
Should You File an Appeal?
The first question to ask is whether you should file an appeal. An appeal is a formal way of expressing your concerns that an error was made in the denial of your claim. If you feel that the claim should have been approved, and you can support that with additional documents, you can start thinking about filing an appeal.
Why was Your Claim Denied?
The next question to ask is why your claim was denied. Make sure you understand the denial letter you received inside and out. If you don’t understand something you’re reading, you can ask Customer Service for clarification. Look for key words like “exclusions” so that you know where to look in your plan document to see the details. The better you understand why your claim was denied, the better you can defend why it should be paid. Make sure you can identify exactly what you disagree with in the denial letter.
What Supporting Documentation do You Need?
The next thing you should ask yourself is what type of documents you need to support your appeal. For example, if you think the medical records from the doctor provided incorrect information, contact the doctor’s office to explain this. They may be able to present you with corrected records and a letter of explanation. This would be the perfect thing to include with your appeal.
The important thing about supporting documents are they must be new, and they must be relevant. Our team needs an appeal that includes documents they have not already reviewed, so do not send the same medical records or other documents again as an appeal. Your claim was processed by licensed analysts who are trained at interpreting policy language, so they already reviewed anything you previously sent. Include new, relevant information that will help them see what they were unaware of before.
Response Time for an Appeal
Once you’ve submitted your appeal, make sure you know the expected turnaround time. At Seven Corners, we review and reply to appeals within 30 days of receipt. You may think this is one of those times when the squeaky wheel gets the grease, but evaluating an appeal involves an important process. It’s important to allow this time for your appeal to be reviewed, and then you are welcome to contact us to see how it turned out.
Reach Out with Questions
As always, let us know if you have questions! Your Seven Corners Customer Service department is available 24/7 to give you the help you need.
