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claimed denied

How to Appeal an Insurance Denial

Has your health insurance company denied your claim? Medicare or your private insurance company. You could be billed for hundreds, maybe even thousands of dollars of medical bills. In most cases, you may be able to appeal the bill.

Winning an appeal can sound like a long shot, but trust us, it’s not. According to Medicare Rights Center, claimants win about 80 percent of appeals for lower payments. The process can be frustrating and often require a significant amount of your time, along with lots of patience and determination.

Medicare and most insurance companies will cover their share of your costs, but it doesn’t always work that way. Sometimes a claim denial can be caused by a minor issue, such as filing the wrong code. That’s an easy fix. 

The Medicare Appeals Process

If you feel that your insurance carrier has made a mistake, you have the right to appeal that decision and don’t give up, even if your first appeal is denied. Medicare has a five-stage appeal process that enables you to move your case up the ladder.

  1. The first stage of the appeals process is a review by a Medicare administrative contractor.
  2. If that fails, your second appeal is reviewed by a qualified independent contractor.
  3. Next comes a review by the Office of Medicare Hearings and Appeals.
  4. The fourth level involves the Medicare Appeals Council.
  5. If you strike out on the first four attempts, you can escalate your appeal to a federal district court. The court will only hear cases involving claims of more than $1,400. (By the time you reach the third level, you may want to retain an attorney.)

You have very little to lose by appealing or resubmitting a claim and potentially a lot to gain. 

The appeals process can be labor-intensive, but having Cosmo Insurance Agency as your broker, we will handle all your claims, so you don’t have to deal with the hassle for no additional charge. 

Cosmo Insurance Agency is a full-service independent insurance agency based in Hackensack (Bergen County) and Lakewood (Ocean County), New Jersey that offers an all-encompassing range of insurance options for both individuals and businesses. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating our knowledge of the insurance guidelines for healthcare, employee benefits, life insurance, self-insurance, dental, disability, and long term care insurance, we keep our clients up-to-date with affordable plans that cover all their specific insurance needs.