Health Insurance Denials
Denied care, denied authorization, denied as experimental. These cover the reasons health insurers give — and the first question, which is who actually regulates your plan.
First: where did your coverage come from?
If this coverage came through an employer, federal law may govern it — which changes your appeal rights, imposes deadlines that are strict, and can displace the state remedies described here. Establish that before deciding how to fight a denial.
The First Question: Who Actually Regulates Your Plan?
Before anything else about a health insurance denial, establish where the coverage came from. Employer-sponsored plans are frequently governed by federal law rather than state insurance law, and that single fact changes the appeal process, the deadlines, and what can be recovered.
Read more →When Insurance Denies Your Surgery or Treatment
Having a surgery or a course of treatment denied as not medically necessary is the most common health denial there is, and the most frustrating, because your own doctor recommended the treatment and someone who has never met you decided otherwise.
Read more →When Insurance Will Not Approve Your Treatment
When an insurer will not approve your treatment before it happens, that is a prior authorization denial, and it stops care before it starts — which makes the timing the whole problem. It also means the argument happens while there is still something to argue about, an advantage worth using.
Read more →When Treatment Is Called Experimental
This denial carries a suggestion that the treatment is unproven or fringe. Frequently it is neither — it is simply a treatment the plan has defined as excluded, and the definition is where the argument lives.
Read more →Out-of-Network Denials and the Bills You Did Not Choose
The hardest version of this is the one nobody chose: an in-network hospital, an out-of-network anaesthetist or radiologist, and a bill afterward for the difference.
Read more →Looking for the law in your state?
These describe how each denial works, which is much the same everywhere. What you can do about one is not — choose the state where your policy was issued.