Winning the Battle Against Health Insurance Denials

Understanding the Process

Health insurance companies often deny treatments, even when doctors recommend them. This can be frightening, but it's not always the end. Many people have successfully won approval after appealing.

Insurance companies use a system called prior authorization, requiring approval before certain treatments, tests, or medicines can be administered. If denied, you can appeal—but nearly half of people find this process challenging.

Why the Process is Difficult

Insurance companies intentionally make the process confusing, hoping you'll give up. But you don't have to. Here’s how to fight back:

1. Know Your Insurance Plan

• Different plans have different rules.
• Read your policy carefully.
• Ensure your insurer follows the rules.

2. Work with Your Doctor

• Your doctor can assist with appeals.
• Request a "peer-to-peer" review, allowing your doctor to speak with a medical professional at the insurance company.

3. Stay Organized

• Keep records of all calls, emails, and letters.
• Note the names of everyone you speak to.
• Maintain paper copies of all documents.

4. Appeal Immediately

• Most denials are overturned upon appeal.
• You typically have six months to appeal.

5. Seek Help

• If insured through work, your employer may assist.
• Many states offer free programs for help.
• Nonprofit groups can also provide support.

6. Go Public (If Necessary)

• Posting about your denial online or contacting lawmakers may yield results.