Research has it that about 20% of claims are tagged “pended” which means it’s flagged for more information. Most times this is due to simple clerical mistakes such as duplicate claims, omitted or mistaken information. Most claims that are tagged “pended” could be resolved with additional information and further processing.
• First and foremost, it’s of great importance to know whom to send your appeal letters to when you are appealing your denial. If you are uncertain about that piece of information, don’t hesitate to call your insurance health plan administrator and ask for the name and address of the right person. It’s also important to send all appeal letters by certified mail so as to have record of having sent the letter and also proof that it was received.
• The first thing to do if your health claim is denied is to enlist your doctor’s help in making your case. Most health insurance plans either grant or deny medical treatment on the basis of if medical intervention is necessary for your well being and whether the treatment you need is suitable for your health condition, ask your doctor to get in touch with the plan’s medical director.
• A follow up procedure would be to ask for more information from your health insurer and imploring your health insurer to reconsider it’s decision, you may have to start with a phone complaint and then get on to a written appeal. File an external appeal if your health insurer won’t reconsider your case. Most states have implemented laws governing external appeal that allows in certain cases, the right to a review by an independent board of qualified experts, your health insurance company will have to reverse their decision concerning your claim if the external appeal board resolves the case in your favor.
