What to Do If Your Insurance Denies a Valid Medical Claim

An insurance denial is not the final word — it is the beginning of a process. Read the denial letter carefully, because it must state the specific reason for rejection. Common reasons include coding errors, missing pre-authorization, or the insurer claiming the treatment was not medically necessary. Each of these has a different path to resolution.

You have the right to appeal, and you should. Contact your doctor's office and ask them to provide a letter of medical necessity or correct any coding errors. Gather all supporting documentation — medical records, referral letters, test results. File your appeal in writing within the deadline stated in the denial letter. If the internal appeal fails, most jurisdictions offer an external review by an independent party. Statistics show that a significant percentage of denied claims are overturned on appeal.