What to Do If Your Health Insurance Company Refuses to Pay for Treatment

March 31, 2025

Health Insurance Companies Regularly Deny Payments

Medical treatment is expensive—even seemingly simple procedures can be astronomical. In Oklahoma, most individuals rely on their insurance to cover medical needs. Sadly, health insurance companies across the state regularly deny payment for medical expenses.

As you would imagine, this catches most people off guard. After all, they paid for their coverage in good faith, believing their insurance company would be there if necessary. Yet, now they stand with a denial letter, concerned that this decision places full financial responsibility on their shoulders.  A good percentage of those who receive these notifications think their insurance company’s decisions are final. Some who are unable to afford care go without, further endangering their health, and even those who are financially able can find themselves in dire straits.

Knowledge is powerful in instances like this. If your health insurance refuses to pay for your treatment, you must act. Don’t accept their decision; be proactive.

It is time to request an appeal from your insurance company. In cases like this, working with a seasoned insurance claims attorney can alleviate much of the burden,  allowing you to focus on your well-being.

Steps to Successfully Appeal

Every day, health insurance companies refuse to pay submitted medical claims. Because these organizations’ primary goal is profitability and most policyholders accept their insurance companies’ responses without question, denying claims is a successful business strategy.

As a policyholder in Oklahoma, it is important to understand that you do have the right to request an appeal.

Your insurance company’s first reply may not be its final response, but you don’t know until you ask.

The idea of addressing a denial is overwhelming. The process is intentionally complicated to discourage policyholders from appealing. If you believe your claim was incorrectly denied, you should prepare to question the decision. Engaging an experienced insurance claims lawyer is the first step in moving forward.

Insurance companies are more likely to grant an appeal and resolve it successfully when a legal professional is involved. These organizations realize they no longer have a leg up — they are now dealing with attorneys who understand the law and insurance company operations, not an overwhelmed individual who is naive about the process.

In addition to engaging assistance,  the following steps can help improve your chances of a successful appeal.

Request a Written Explanation for the Denial

Not all insurance correspondence provides the specific reasons for denial.  Understanding the basis for the decision is important, because your appeal must address it.  Contact your insurance company and request their reasons, in writing. You do not want to have this conversation over the telephone; you need proof of everything they say. Oklahoma law requires health insurance companies to provide all denials in writing and to indicate the policy provision for their reasoning.

Additionally, administrative filing and technical errors are not cause for a final denial. Mistakes like failing to check a box or omitting certain medical records can be rectified and claims resubmitted. Don’t accept minor administrative errors as valid reasons for denial.  That said, it is always best to file your claim according to the directions provided in your policy; complete and correctly submitted claims are more likely to be paid.

Review Your Insurance Policy Carefully

One of the keys to filing a successful appeal is determining whether or not your claim is a covered expense.  Read yours carefully to recognize whether:

• Your claim was submitted correctly and within the statute of limitations
• Your deductible was met.  Many insurance plans have individual and family deductibles which must be met before receiving reimbursement.
• Your service provider (physician, hospital, or lab) is a plan member.  Most insurance companies contract with doctors, hospitals, and facilities; only services provided by members will be covered at the rate described in your policy.  If you visited an out-of-network provider, your claim may be covered at a lower rate or denied.
• The treatment you need is covered. Some, like plastic surgery, may be classified as elective and not covered. Other costly procedures may be denied; your insurance company may want you to first try less expensive options.  Some policies may exclude treatment categorized as experimental.  If your claim was denied for the above reasons you may be able to file a successful appeal.

A health insurance claims attorney can be helpful in this process. Policy language can be technical and difficult for a layperson to understand.

Gather Critical Information

To file a letter of appeal you will want to have all relevant documentation available to include as an attachment. You want to make the appeals process as simple as possible for the insurance company; they won’t hunt for old submissions or other paperwork. Ensure you have these items:

• A copy of your claim
• The denial letter
• Your insurance policy (highlight the relevant portion that substantiates that your claims should be paid)
• All medical records
• Letters from your physician
• Copies of research that support the value of the denied treatment.

Involve both your attorney and doctor in this process. The attorney can help identify exactly what you need to provide, and your physician can help identify research and provide letters of medical necessity.

Draft a Health Care Insurance Appeal Letter

Your appeal letter should be polite and to the point while also detailing why your claim should be paid.  Make sure that the letter includes all relevant administrative information including your name, address, telephone number, insurance policy number/member number, and reference numbers for all submitted bills.

Succinctly describe the treatment, focusing on its medical necessity.  Describe how it will affect your ability to live a productive life, and the impact of not receiving it; ensure it is clear that this is the singular option that could help you.

While some of the reasons for denial may seem accurate at first, after investigation, you will realize they are invalid. For example, certain facilities that are out of network may be in the network for specific procedures.  Treatment described as experimental may be covered if proven successful in the past and necessary in the current situation.  Sometimes providing a letter from your doctor can help prove medical necessity and result in a decision change.

Submit Your Letter Correctly

The most persuasive and substantiated appeal letter is useless if not reviewed and considered. How you submit your appeal is as important as the letter’s contents.

Carefully review the appeal process to identify how documentation needs to be submitted –electronically via email, uploaded to an insurance company portal, or mailed in hard copy. Mailing an appeal letter that needs to be uploaded to a portal can render your attempt at compensation useless.

Finally, if you need to submit a hard copy of your appeal, keep copies of everything you provided, and utilize certified mail that requests a signature to prove receipt.

If you need to follow up, do so in writing.  If you must call, follow all conversations with an email summarizing your conversation. Always create a paper trail.

Doug Terry Law Successfully Address Health Care Claim Denials

Our Experienced Team Can Help You Appeal Your Insurance Company’s Decision

An insurance company’s refusal to pay for necessary medical treatment leaves patients either unable to access the care they need or financially responsible for the cost of their treatment. If you are in this position, consider speaking with a denied healthcare claims attorney at Doug Terry Law.

The firm was founded by Doug Terry, a seasoned professional who began his career in the insurance industry. His first-hand exposure to the treatment of policyholders left him disillusioned, inspiring him to start a law firm designed to provide ordinary people with extraordinary service, counsel of the same quality as their insurance companies’.

He and his team understand the tactics these organizations take, and they know how to combat them. They can identify and prove bad faith actions and quantify additional damages resulting from them.

Their dedication to their community is long-standing and their commitment to compassionate and quality service is considerable. Their reputation is outstanding.

Don’t Wait – Contact Doug Terry Law Today

Time is valuable when payment for your necessary health care treatment has been denied. While adhering to the statute of limitations is critical, resolving your issues for your physical and emotional well-being can be even more important.  The sooner you engage professional reputation, the sooner your appeal can be filed.

Doug Terry Law recognizes how time-sensitive these appeals are; as such, they are available to provide you with a no-risk, free consultation immediately.  Contact them today at 405-463-6362 to schedule a meeting with one of their seasoned attorneys and learn how they would approach your case.

In every situation, they strive to minimize the overwhelming stress that accompanies health insurance appeals and maximize compensation for those they represent.  Bad faith health insurance denials are unconscionable — people’s lives are at stake.  They are ready to help you.