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Response to Denial of Medical Insurance Claim

Denial of Medical Claims in the first round is like tennis, as they lob the ball over the net to “see what you will do.” It is standard practice for them. Your first job, then, is to answer immediately, if not sooner. Poundage in your response weighs heavily in their analysis of your both your claim and your conviction to pursue it.

Once you understand the game, you will be able to play it better. Think of it from their point of view: if just 10% of claims go uncontested, their bottom line improves immeasurably. As the numbers escalate, and I suspect it is a far higher number than 10% that don’t respond to the initial computer generated letter, this is an enormous profit center (they might say “screening” device) for them.

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