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What should you do if your medical claim is denied?

Many of those in Salem who have health insurance may be surprised to learn that simply having it does not necessarily guarantee coverage. Insurance claim denials may easily cause worry, given that medical debt is the primary reason behind most personal bankruptcies in the U.S. So what should you do if your medical claim is denied?

First and foremost, do not panic. There could be any number of reasons why your claim was denied, some which may be easily remedied. The National Association of Insurance Commissioners recommends taking the following steps to try and have an insurance denial overturned:

  •          Read through your policy: Every insurer is required to provide enrollees with a Summary of Benefits and Coverage. Reading through that will not only help you understand what services may be covered, but it also may familiarize you with the terminology to use when appealing your claim.
  •          Contact your insurer: Call the customer service number on the back of your insurance card. Ask why your claim was denied as well as what actions may be taken to have it reprocessed. Oftentimes, the denial may simply be due to a clerical error.
  •          Call your healthcare provider: If your denial was due to an error, you should call your provider’s office with the suggested remedy and have then resubmit the claim.
  •          Appeal the denial: Send in a letter to your insurer asking that the claim be reprocessed. Include information from your provider stating why the exact care you received was medically necessary.

Appealing your claim may at least serve as proof of your effort to resolve your medical debt. While the information given above should not be considered to be legal advice, it may end up being taken into account should you need to take more serious debt relief measures. 

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