How to Appeal a Denied Health Insurance Claim in New York

Facing a denied health insurance claim can be frustrating, especially when you rely on your policy for medical coverage. If you're in New York and your health insurance claim has been denied, there are specific steps you can take to appeal the decision effectively.

1. Understand the Denial Reason

The first step in appealing a denied health insurance claim is to understand the reasons behind the denial. Health insurance companies are required to provide a written explanation detailing why your claim was not approved. This information can usually be found in the Explanation of Benefits (EOB) statement. Common reasons for denial include:

• Services not covered under your policy
• Incorrect coding or billing errors
• Insufficient medical necessity documentation
• Claims submitted after the deadline

2. Review Your Insurance Policy

Next, take a close look at your health insurance policy to identify the coverage specifics. Ensure that the service you are appealing is covered under your plan. Familiarize yourself with any exclusions or limitations that may apply to your situation. This information will support your case during the appeal process.

3. Gather Supporting Documentation