Main > Insurance Tips

What to do if a health insurance claim is denied.

What rights do you have if your health insurance claim is denied? Over the past several years, states have developed an independent medical review board designed to review health coverage plan decisions. Health plan enrollees have the right to appeal plan decisions involving a denial of coverage. The board is an independent review entity, which can be a private organization and is approved by each state. Because state laws can vary widely, the independent review process is designed to review health insurance claim denials based on medical necessity or a determination that the service is experimental or investigational. If you feel you would like to present your case to the appeal board of your state, contact your state health department. Ahip.org statistics say one appeal is filed for every 14,000-health plan enrollees.