If At First Your Health Insurer Denies Your Claim, Try Try Again

Among the items on recent list of things your health insurer won’t tell you was the fact that you shouldn’t give up if your insurance claim is initially denied. Now a new report from the Government Accountability Office says that upward of 50% of appealed claims ultimately get paid.

While the GAO was only able to study a few states for its report, in both Maryland and Ohio, nearly 50% of appeals led to reversals in 2009.

But the GAO is quick to caution that these findings don’t imply that every denied claim has a 50% chance of being reversed. Appealed claims were only a small portion of the total number of denied claims.

One of the most frequent reasons for claims being denied is an error in the billing code.

“You’ve got a lot of people in America who are ultimately paying a bill they don’t owe because they don’t realize it’s an incorrect code,” the CEO of Patient Advocate Foundation, a nonprofit that helps people appeal claims denials, tells the Associated Press.

So if you truly believe that your claim was denied because of a billing error or other mistake, don’t be afraid to challenge the insurer. As a number of you pointed out in the comments to the earlier story, it’s sometimes the only way you were able to get coverage.

Study: Many health insurer appeals work [DetNew.coms]