How to Appeal a Denied Health Insurance Claim

April 22, 2025

If you have received notification that your insurance carrier has denied your health insurance claim, you are aware, of the stress and anxiety caused by this communication. Many in this position don’t realize how often this happens; in fact, every day many individuals in Oklahoma get this unfortunate news.

Knowing how to appeal a denied health insurance claim is important; taking the right steps can impact your insurance company’s response.

Because so many people don’t realize they have the right to appeal these decisions, insurance companies continue to regularly deny otherwise valid claims. These actions that are often taken in bad faith result in lower expenses and higher profits, outcomes that incentivize insurance companies to continue these practices.

Understanding your rights and deciding to take action is critical. Doing nothing indicates your acceptance of the decision as rendered and leaves you financially responsible for what may be costly treatment.  Some individuals may even be unable to get the help they need because the costs are out of reach.

Managing an appeal is complicated under the best of circumstances. Because of this, engaging an experienced Oklahoma denied health care claims attorney is a good investment. They know both what to do and how to do it.

Filing a Health Care Claims Appeal Is a Multi-Step Process

Embarking on a health insurance claim appeal is like preparing for a marathon — you must prepare. Just like you cannot simply lace up your sneakers and run 26.2 miles, you can’t open your email, fire off a quick note, and hope to be successful with an insurance appeal.  You need to take time to understand specific issues and gather relevant documentation.

Get Help

The first step in mounting a successful appeal is identifying and engaging a reputable denied health insurance claims attorney.  This professional can assist with the appeals process.  The combination of legal, insurance, and medical terminology can only be described as technical, and the appeals process, as determined by your insurance company, is purposely complex. Managing it alone is time-consuming, and there is considerable room for error.

Additionally, individuals who work with a bad-faith insurance attorney are more likely to have their appeal upheld than those who manage these situations alone. Insurance companies realize that getting an attorney involved levels the playing field.

Gather  Insurance Company Correspondence

Understanding the details in all insurance company materials and letters is crucial for building a successful appeal. In light of this, you must provide your health care denial lawyer with copies of your insurance policy, your claim submission, the denial letter, and any other correspondence you have had with the company.

Policies do have limitations.  Because not all policies are the same, understanding the specific coverage to which you are entitled, as outlined in your policy documentation, is important.  Details like deductibles, co-payments, participating physicians and facilities, and covered procedures can differ from policy to policy.

You also need to share a copy of your claim submission in its entirety.  Submission requirements can also vary from company to company. Your lawyer needs to review these documents to determine whether your claim was submitted correctly and whether you are entitled to the reimbursement you requested

Identify Reasons For Denial

There are several reasons why insurance companies deny claims.  Your attorney will review your carrier’s reasons and help to determine whether they were made in good faith.  Some of the most common reasons for denial include missing information, incorrect medical codes, use of out-of-network providers, pre-existing conditions, experimental treatment, and even uncovered procedures.

Submission errors, like missing information or incorrect medical codes, are known as technical errors and are not grounds for a permanent denial.  That said, you must resubmit your claim correctly.

Finally, health insurance companies implement deadlines for appeal submissions.  Failure to adhere to them is a valid reason for denial.

Gather Necessary Evidence

If your attorney believes you have grounds for an appeal, they will ask you to gather documents to support your claim.  These may include, but are not limited to:

• Medical records
• Physician letters
• Copies of all correspondence with your insurance company, including pre-authorizations
• Explanation of benefits
• Second opinion/independent provider reviews
• Letters of medical necessity
• Copies of professional studies (when the reason for denial was that the treatment is experimental).

Your insurance claims denial lawyer will use this information to support their reason for an appeal and a change of decision.

Write the Appeal Letter

Appeal letters should be concise, polite, and to the point.  They must contain all relevant information (insured’s name, policy number, and date of birth), clearly state why the denial was incorrect, and reference all supporting documentation (which must be attached).  Your attorney can draft this letter, leveraging their knowledge of the health care insurance industry and the tactics insurance companies use when denying otherwise valid claims.

Keep in mind that how you submit your appeal letter matters. Instructions for appeals should be in your policy and must be followed exactly. Not all companies want a hard copy mailed to them; some require the use of website portals, while others may ask for an electronic transmission. Adhere to their requirements, but always keep a copy of everything you send.  And, if you do need to submit a hard copy, make sure you do so via certified or express mail, where you can request a delivery receipt.

If your appeal is upheld, your claim will be covered at the level stated in your policy.  If your appeal is denied, you may have the opportunity to escalate your action by requesting an external review.

When external reviews are denied and attorneys believe that insurance company bad faith actions are at play, moving forward with a lawsuit may be in your best interests. If your attorney is able to prove that your insurance company acted in bad faith, you could be awarded a settlement of actual damages, consequential damages, and punitive damages.

Doug Terry Law Can Help You Appeal a Denied Health Care Claim

Be Smart – Engage Professional Representation

Every day, we reach out to professionals, expecting them to leverage their knowledge and experience with tasks that lie directly in their wheelhouse. We call on CPAs to file our taxes, mechanics to repair our vehicles, and financial advisors to plan for retirement. They can manage these specific jobs better than we can.

Knowing this, it makes sense to work with a denied health care claims attorney when an appeal needs to be launched. This decision puts you on equal footing with your insurance company.  They employ a host of attorneys to defend their positions; you cannot compete effectively alone, you simply don’t have the knowledge or skills.

This is where Doug Terry Law can help. Doug Terry, the founder of the firm, began his career working for insurance companies. He recognized the disadvantage of policyholders with regard to denials; they didn’t know enough to effectively advocate for themselves. He made the conscious decision to build a firm designed to even the playing field by providing everyday people with high-quality legal representation.

Over the past 10 years, his firm has earned an outstanding reputation based on its compassionate approach to service and its record of success.

Throughout Oklahoma, they are well-known for the work they do.

Time Is Valuable – Act Now

Where healthcare is concerned, time is a valuable commodity. If your claim has been denied, you want to act quickly and decisively. Not only are deadlines regarding appeals very real, but your health and financial stability are also at risk.  You must have your claim approved to pursue treatment and/ or pay your outstanding medical bills.

Doug Terry appreciates the need to act quickly and is available to meet with all potential clients immediately. He also understands the importance of feeling comfortable with the individual you choose to represent you; thus, he provides all potential clients with a free consultation. Contact the firm today at 405-463-6362 to schedule yours and see how they suggest moving forward.

Denying qualified healthcare claims as a business strategy is reprehensible and illegal. Doug Terry Law can review your claim denial, draft an appeal letter, and pursue compensation for bad faith.