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Dealing with health insurance coverage denial

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There may come a time when your insurance company denies covering a treatment, procedure, or medicine your doctor recommended. This can happen before or after you have received the treatment, procedure, or medicine.

Steps to take if your coverage is denied

  • Contact your insurance case manager and ask why your claim was denied. They will be able to tell you if information is missing or if the treatment was denied for other reasons.
  • Ask your case manager about your insurance company’s appeal process and the steps you take to challenge a denial.
  • Talk with your doctor’s office and ask for the person whose job it is to handle appeals and provide records of your treatment and needs.
  • File an internal appeal, asking for your insurance company to review its decision.
  • File an external appeal by contacting your state’s insurance agency.

For more information about appealing denial of coverage, visit Triage Cancer’s Quick Guide to Appeals for Employer-Sponsored & Individual Health Insurance.

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Reviewed and updated: October 7, 2024

Reviewed by: Aimee Hoch, MSW, LSW, OSW-C, FACCC

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