Nevada Insurance Enrollment logo - Nevada State outline divided into four colors of dark blue, light blue, orange and yellow

Filing An Appeal To A Health Insurance Company

by | Nov 30, 2024

Page Tags: 2024 | billing / claims

Denied Health Insurance Claim? Here Is What to Do Next

If you experience a serious injury or illness, the last thing you want to worry about is high medical bills. Fortunately, if your health insurance company denies coverage for a claim, you have options. A health insurance agent can help you figure out why your claim was denied and whether you have grounds for an appeal. Other reasons for filing an appeal may be that your medication you are taking is not listed as a covered medication or you have hospital bills from an out of network provider. You can file an appeal to get these items covered, however, they are not guaranteed to be approved.

Call for FREE Help
(702) 898-0554

↑ click to call ↑

Filing An Appeal To A Health Insurance CompanyPin

Why Do Claims Get Denied?

Health insurance claims get denied for a myriad of reasons. In some cases, denials result from clerical errors. Maybe your health care provider’s billing staff entered an incorrect code, or maybe the claim was accidentally sent to the wrong health insurance company. Other times, the issue may be related to your coverage limits.

 

You Have a Right to Appeal Denied Health Insurance Claims

If your health insurance company refuses to cover a claim, you have the right to appeal the decision and have it reviewed by a third party. Your policy should outline how to appeal a denial. In general, there are two levels of an appeal, including an internal appeal and a third-party external review.

 

Internal Appeal

Your first step for resolving a denied claim is to call your health insurance company and ask that it conducts a full review of the decision.

First, you need to complete all forms required by your health insurance company or send a letter to an insurer explaining the reason for your appeal. You must include your name, health insurance ID number and claim number in this letter. Then, submit any relevant additional information, such as a letter from your doctor explaining why the service is necessary. If you need help filing the appeal, the Consumer Assistance Program in your state can file on your behalf. If you have an agent/broker they can assist you at no cost to you.

You have 180 days from the time your claim was denied to file an internal appeal. If your health situation is urgent, or if the health insurance company stands by its original decision, you can simultaneously file an external review.

Quote and or EnrollPin

External Review

To have your denial handled by a third party, you can file an external review. You must begin this process within four months of the date you receive the final determination from your health insurer that the claim has been denied. Someone else, such as a doctor or health insurance agent, can file an external review on your behalf.

This process may be the best option if your claim was denied because the health insurance company did not believe the service was medically necessary and your doctor disagrees. You may also request an external review if your health insurance canceled your policy because it claims that you provided incorrect information when you first enrolled.

In Nevada, as in all states, health insurance companies are legally required to accept the outcome of the external review.

 

Nevada Insurance Enrollment Helps You Navigate the Appeals Process

The appeals process can be frustrating, but at Nevada Insurance Enrollment, our health insurance agents can help. We can review why your health insurance claim was denied and help you through the next steps.

Health Insurance Notices from EmployersPin

Health Insurance Notices from Employers

Employer health insurance notices explain how Nevada employees can explore Marketplace options. Learn how to use these notices to compare costs, check subsidy eligibility, and make informed decisions.

Does My Age and Gender Affect My Auto Insurance Premium?Pin

Does My Age and Gender Affect My Auto Insurance Premium?

Curious how your premium affected by age and gender impacts auto insurance in Nevada? Learn why age, gender, and other factors like driving record and vehicle type influence rates. Understand Nevada’s minimum liability coverage and discover cost-saving tips to manage your premium. Nevada Insurance Enrollment helps you find a policy that fits your needs.

Why Have PPO Plans Vanished from Nevada’s Individual Market?Pin

Why Have PPO Plans Vanished from Nevada’s Individual Market?

The PPO plan decline reflects a Nevada health plan shift, with Nevada Health Link offering HMO/EPO plans due to ACA rules and record 2025 enrollment. These plans limit provider choices but ensure affordable coverage. Learn why PPO plan reduction occurred and how to choose coverage.

 

By page visits (this month)

#1) Health Insurance Subsidy Chart

#2) Health Insurance

#3) Health Insurance WITH a Subsidy

#4) Insurance Blog

#5) Request a Quote

Health Insurance Notices from Employers

Employer health insurance notices explain how Nevada employees can explore Marketplace options. Learn how to use these notices to compare costs, check subsidy eligibility, and make informed decisions.

Does My Age and Gender Affect My Auto Insurance Premium?

Curious how your premium affected by age and gender impacts auto insurance in Nevada? Learn why age, gender, and other factors like driving record and vehicle type influence rates. Understand Nevada’s minimum liability coverage and discover cost-saving tips to manage your premium. Nevada Insurance Enrollment helps you find a policy that fits your needs.

Why Have PPO Plans Vanished from Nevada’s Individual Market?

The PPO plan decline reflects a Nevada health plan shift, with Nevada Health Link offering HMO/EPO plans due to ACA rules and record 2025 enrollment. These plans limit provider choices but ensure affordable coverage. Learn why PPO plan reduction occurred and how to choose coverage.

Health Insurance Benefits for American Indians

Health insurance for American Indians offers zero cost-sharing, monthly enrollment, and IHS access via Nevada Health Link. The ACA ensures affordable Nevada tribal health coverage with premium tax credits and Medicaid/CHIP options. Learn how to navigate tribal health insurance benefits.

Share this page...