5 Tips for Writing an Insurance Appeal

Insurance appeal
Insurance appeal

By Amanda Buchanan, The Motley Fool

According to the most recent study done by The American Journal of Medicine, 62.1% of all bankruptcies in 2007 were related to medical expenses. That's a surprisingly large number. Even more surprising is that the majority of debtors owned homes, were well educated, and held middle-class occupations with health insurance. Last week, we showed you how to check your hospital bill to make sure you weren't being overcharged. This week, we'll show you what to do when your insurance company refuses to pay.

1. Know your policy.

Not only should you always be aware of procedures that your policy does and does not cover, but you should also be aware of the appeal process. According to Brett Goldstein, author of The Retirement Crisis, most insurance policies offer two or even three opportunities to appeal, as long as it's done in a timely fashion. The first appeal should typically be filed within 180 days of the denial.

2. As part of your appeal, you'll need to write a letter.

As tempting as it may be to go off on a rant about why you think your insurance company is evil for not paying in the first place, you'll get much better results if you can get an attorney or doctor to help you write this letter. You'll need to start the letter with your policy and claim numbers, and the reason the company gave you for the denial. Then you can go into why you think that decision was wrong and what you are asking the insurance company to do -- typically, to reconsider the denial and approve coverage.

3. Doing a bit of research to find supporting facts and peer-reviewed articles will really go a long way in making your case.

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Your doctor probably already knows about a few key articles, so don't be afraid to ask. You should also ask him or her to write a letter explaining why your treatment was medically necessary.

4. You should ship all of your letters, supporting articles, and medical records together in one packet.

Make sure to get a tracking number so you can see when the insurance company receives it and who signs for it.

5. If you've maxed out your appeals with the insurance company and it still refuses to pay, then you can go to your state's insurance department and file an appeal there.

A quick Google search can help you find your state department's contact information.

The appeal process can be frustrating, time-consuming, and expensive if all of your work proves unsuccessful. Goldstein points out that it's important to remember that, unlike in the movies, if your health insurance is provided through your employer, there won't be a trial by jury if you choose to sue your insurance company. This means that a judge will review your case using only the letters and articles from your appeal packet as evidence. That's why it's critical that you take the time to really do the research and make your case when putting together that packet.

Amanda Buchanan is a contributing writer for The Motley Fool.