What to Do If Your Insurance Claim Gets Denied: Step-by-Step Guide
Okay, so picture this: you’ve just gone through something super stressful—maybe a car accident, or you had to go to the ER, or your house got some water damage—and you’re like, “Whew, at least I’ve got insurance.” You file the claim, cross your fingers, wait a few days... and boom, denied. Like what? Seriously??
If your insurance claim gets denied, don’t panic. It sucks, yeah, but you’re not out of options. Actually, way more people go through this than you’d think. Insurers reject claims for all kinds of reasons—some are valid, but a lot are just... meh, not great. So here’s what you can actually do if this happens. I’ll break it down without all the boring legal stuff.
First, find out why it got denied
This sounds obvious, but sometimes the denial letter is vague or just full of jargon. You need to know the actual reason. Did they say you filed too late? Is the damage not “covered”? Maybe they think it was “pre-existing” or not “medically necessary” if it’s health insurance.
Ask for the denial letter in writing if you don’t have it already. You’re legally allowed to have it. And sometimes, the reason is something you can fix—like missing documents or a code error in a hospital bill.
Don’t ignore it — there’s usually a deadline to appeal
A lot of people just drop it here, especially if the amount is small-ish. But you’d be surprised how many denials get reversed if you appeal. According to the Kaiser Family Foundation, something like 40% of people never appeal a denied health insurance claim—and out of the people who do, a decent chunk actually win.
Thing is, you don’t have forever. Some insurance companies give you 30 days to appeal. Others give you 90. Check your denial letter or your policy—it’ll be there somewhere, even if it’s buried.
Call them and ask questions
Honestly, before you even write the appeal, call the insurance company. I know—nobody likes calling customer service—but this can really help. Be polite but firm. Ask them to walk you through the reason. Sometimes they’ll even tell you what exactly you need to send in to get it approved.
Write down everything: who you spoke to, when, and what they said. It might help later.
Gather your proof
Okay, here’s the part where you kinda need to play lawyer-lite. You need to show them why they’re wrong.
For health insurance? Ask your doctor to write a letter explaining why that treatment was medically necessary.
For car insurance? You might need more photos, a police report, or an estimate from a repair shop.
For home insurance? Maybe a contractor’s report or receipts for stuff you replaced.
This is annoying, yeah, but it’s worth it if you’re dealing with hundreds or thousands of dollars.
Write your appeal (don’t worry—it doesn’t have to be fancy)
You don’t need a lawyer for this. Just keep it simple, honest, and stick to the facts. Say why you think the claim should be covered. Include your policy number, the date of the incident, and any reference number from the denial.
Attach the supporting documents you collected, and double-check everything before you send it. If you can, send it certified mail or through the insurance portal so you’ve got proof it was delivered.
Escalate if you have to
If they still deny it after your appeal, you’re not done yet. You can file a complaint with your state’s insurance department. Every state has one—it’s literally their job to keep insurance companies from being shady.
Also, you might qualify for something called “external review” for health insurance claims. That means someone outside the insurance company will look at your case. According to the Affordable Care Act, you’ve got the right to ask for that in many situations.
A few pro-tips no one tells you
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Keep every single document—emails, letters, bills, screenshots. All of it.
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Be super organized. Create a folder just for this.
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Don’t assume the insurer is always right. They mess up. A lot.
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And don’t give up just because it feels overwhelming. That’s kinda what they’re hoping for.
It’s frustrating, I get it. You’re already dealing with whatever incident made you file the claim in the first place—and now this. But pushing back can totally work. Just take it step by step. You’ve got rights, even if the paperwork makes it feel like you don’t.