| Health Insurance denials can happen for a number of | | | | Washington Health Insurance Agency provides |
| reasons. A simple cause can be a billing error from | | | | assistance through the appeals process, by walking |
| the provider's office. If the claim is submitted using | | | | their health insurance clients through the steps, |
| the wrong treatment or diagnostic code, the claim | | | | carefully tracking the appeal deadlines, recommending |
| can be denied. More serious reasons can involve | | | | the best supporting documents, and even |
| treatments considered "experimental" or | | | | participating in the appeal discussion board via |
| "pre-existing". Both of these reasons can be appealed | | | | conference call on behalf of their clients. |
| if you feel the insurance company's decision is wrong. | | | | The most important thing to remember is that if you |
| If your healthcare claim is denied, you have the right | | | | feel the denial is wrong, you have to appeal. Many |
| to appeal. Health Insurance carriers are required to | | | | people just assume there is nothing they can do. |
| provide an appeals process. Typically there are a few | | | | Often the claim denial can be reversed with a simple |
| levels of appeal, each moving more 'independent' by | | | | phone call, and the appeal process can be avoided |
| involving impartial medical professionals. Washington | | | | altogether. Reason Codes are found on the |
| State also provides the Patient's Bill of Rights which | | | | Explanation of Benefits statement from the insurance |
| provides an independent third-party review of your | | | | company that can provide useful information in |
| appeal, if the standard appeals process is | | | | determining the reason for a claim being denied. It's |
| unsuccessful. | | | | up to you to check your statements carefully. |