March 5, 2024

If you paid your health insurance premiums on time, believed the treatment you received was covered, and submitted your claim correctly, you likely assumed it would be paid appropriately and in a timely fashion. A denial of the claim would likely leave you frustrated at the process and worried about your financial responsibility. These concerns are real . . . but there is good news.

You do not have to accept your insurance company’s denial as final.

There are steps you can, and should, take. Knowing what to do and who you can rely upon for help is the first step toward appealing your claim.

Health Insurance Claim Denials Are Common

The Kaiser Family Foundation Tracked Insurers’ Denial Rates

Insurance claim denials are aggravating; if you have experienced this you know exactly what we mean. Unfortunately, you are not alone in this experience. In fact, according to a survey performed by  the Kaiser Family Foundation “roughly 6 in 10 insured adults experience problems when they use their insurance. Problems studied include denied claims, network adequacy issues, preauthorization delays and denials, and others.” This survey also uncovered a host of facts relating to health insurance denials, including:

  • Private insurers denied more claims than public insurers.
  • Individuals who have more doctor visits have higher denial rates than those with fewer.
  • Those who identify as LGBTQ+ have a higher percentage of claims denied.

Those whose claims were denied faced a combination of issues, including not getting the care they needed in a timely fashion and increased out-of-pocket costs.  Sadly, the majority of those surveyed who have had their claims denied did not know that they could appeal their insurer’s initial decision.

Knowledge Is Power

You Must Understand Your Explanation of Benefits

Your Explanation of Benefits, often referred to as an EOB, is one of the most important sources of information when it comes to health insurance claims. You receive this document from your insurance company after your provider submits a claim. The information below will be included on your EOB:

  • Patient name
  • Service Date
  • Provider
  • Out-of-pocket Maximum
  • Deductible
  • Insurance ID Number
  • Claim Number
  • Service Information
  • Billed Charges
  • Charges Not Covered
  • Paid Charges
  • Amount not Paid
  • Patient Cost/Insurance Co-payment
  • Total payment cost.

Your EOB provides a complete insurance summary of your visit. It is important to review these details and make sure they are correct.  Errors can affect your reimbursement. If you identify what you believe to be a mistake, you should contact the number provided on your EOB.

If you believe your EOB is incorrect and your insurance company has improperly denied your claim, you have further recourse and can file an appeal.

Use the Designated Appeals Process

Perhaps the most important thing to do when handling a denied claim is to make sure to follow the insurance company’s designated appeal process.  It is important to recognize that each insurance company has its own set of instructions. Failure to follow them exactly can mean your appeal will not even be considered.

It is likely that the appeals process is described on your insurance company’s website. Information provided may include links to specific forms that must be completed, instructions on submission methods (fax, scan and email, hard copy mail or upload to a server), and notification of deadlines.

There is likely a window during which you can file an appeal, and missing the deadline can negate your opportunity to have your case reviewed.

Throughout the appeals process, make sure to conduct all communication in writing and keep copies of everything you submit. This information can be helpful if you need to further pursue your denied claim and begin legal action.

An Insurance Lawyer Can Help Fight an Insurance Claim Denial

Contact Doug Terry Law Today

Many in Oklahoma find themselves dealing with unreasonable and unfair insurance claim denials.  Unfortunately, denying claims is in the insurance companies’ best interests. Because the majority of people don’t appeal their denials, these companies recognize increased revenues, which reflects positively to their shareholders. If your health insurance claim has been unfairly denied, you should take action.

Truthfully, the process to appeal these decisions can be overwhelming. Policy language is technical, and the appeals process is purposefully confusing. Engaging the assistance of an experienced and reputable denied insurance claims attorney can prove incredibly valuable.

Attorney Doug Terry and his team in Oklahoma are well-versed in handling denied health insurance claims and have a reputation for helping their clients successfully appeal erroneous decisions and identify bad faith actions. Mr. Terry leverages the knowledge he gained in his past experience defending insurance companies each day; he now helps his clients address their denied claims. He has decades of experience and a reputation for providing compassionate and quality service.

If your insurance claim has been denied, reach out to Doug Terry Law today at 405-463-6362 to schedule a free consultation. During this meeting Mr. Terry can review your insurance denial, identify whether you have a valid concern and share how he can help you pursue action.

Denied insurance claims impact your health and your financial well-being. Inaction means you accept responsibility for the expenses denied. You do have recourse:  contact Doug Terry Law today.

Attorney Doug Terry

Attorney Doug TerryAfter 25 years practicing in a larger firm, Doug chose to open his own practice in Oklahoma City. He brings his wealth of knowledge and his skills as a litigator to bear for his clients in matters of insurance bad faith, personal injury cases and class actions. He won $200 million and $25 million verdicts for clients in cases in which an insurer denied a health insurance claim. Doug has the distinction of being awarded a Martindale-Hubbell “AV Preeminent” rating from his peers in the legal community. He has also been selected as an Oklahoma Super Lawyer. [Attorney Bio]