If your claim is denied, start with a few basic questions:
- Was your insurance coverage in effect at the time of the service?
- Was the healthcare service a covered benefit? Was it medically necessary? Learn more.
- Was the care provided by an in-network provider?
- Were all necessary referrals or preauthorization from your insurance company in place? Learn more.
If you think the services should have been paid, you may want to ask your insurance plan to reconsider. If that doesn't work, your next step is to file an appeal.
Appeal process help:
- Insurance companies have an appeal process. Carefully follow their steps. Appeal information should be included on your Explanation of Benefits (EOB), in plan booklet, and on the insurance company's website. The information on your EOB will help you understand why the insurance company denied the claim. You can also call your insurance plan for information about the reason for denial and details on the appeal process. Make sure you understand any timing requirements or limits.
- Be aware that it takes time to go through the appeal process. The appeal often takes 30-90 days to be completed. Talk to your healthcare provider's office and let them know that you are appealing the denial. Appeals often need further information from the doctor. The staff may be able to assist and you want them to know that you are not ignoring bills for their services.
- If you are unable to get the help you need from the insurance company or your employer, contact the New Hampshire Insurance Department. The Insurance Department can provide assistance, including help with appeals.
- If you are unable to pay the amount owed, ask if the provider will consider a payment plan. If the appeal fails (or is only approved for a portion of the charges) and you have tried all other options, most providers will work with you to create a payment plan. If the provider agrees to any payment terms, ask to get the plan in writing.