Your Coverage & Care
Your Coverage & Care
 
Appealing Denied Claims

Appealing Denied Claims

Depending on the type of health coverage you have, you will need to follow specific steps in the appeal process. This information will familiarize you with common appeal terms, help you understand why your claim was denied and give you a step-by-step overview of different appeal processes.

Common Reasons for Claim Denials

Claim denials usually fall in one of three categories: coverage issues, appropriateness of services and process errors.

Common Medical Billing Errors

Medical billing and coding errors are unfortunately common. That can cause your claim to be denied or increase what you have to pay out of pocket. Here are a few errors that may cause claim problems.

Appeal Process – Commercial, Employer and Health Exchange Plans

Learn about the important steps in the appeal process.

Appeals Process – Government-funded Plans

Learn about the important steps in the appeal process.

Glossary of Appeal Terms and Definitions

Understand commonly used insurance appeal terms and definitions. This is not a complete list and should be used for general information purposes only. Your insurance plan documents may use variations of these terms.

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