Health Insurance Claim Denied? See What Insurers Said Behind the Scenes

[Passages]

Learn how to request your health insurance claim file, which can include details about what your insurer is saying about you and your case.


Want to request your claim file? Visit our free Claim File Helper tool. Want a pamphlet version of this guide? We’ve made a kit for health care providers, support groups and others to share. Request a packet here.

When a health insurance company is deciding whether to pay for your medical treatment, the company generates a file around your claim. All the records associated with your case should be part of your file. This includes documents explaining the reasons your claim was denied.

You have a right to see this file. Federal regulations require most health insurance plans to give people an opportunity to review documents related to their claim for free. So if your insurer talks to your doctor, if a nurse takes notes, or if two people speak about it on the phone, all of those records should be available to you.

“It’s a treasure trove of information,” said Juliette Forstenzer Espinosa, a health lawyer and senior lecturer of health policy at George Washington University. “But most people have no idea how to get it.”
https://www.propublica.org/article/find-out-why-health-insurance-claim-denied?utm_campaign=propublica-sprout&utm_content=1716724801&utm_medium=social&utm_source=twitter

[Diamond_Dog]

1. Thank you for posting this, it's invaluable information.

[LizBeth]

2. Working within insurance doing claims, there really is not a lot of information in denial

I mean very little, minimum. Just no adjustment. Or upheld.