How to Appeal a Rejected Health Insurance Claim

Introduction

Having your health insurance claim rejected can feel overwhelming.
However, most rejections can be appealed successfully if handled correctly.

This guide explains how to appeal step by step.

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Step 1: Understand the Rejection Reason

Insurance companies must provide a reason for rejection.
Common reasons include:

• Missing documents
• Policy exclusions
• Incorrect billing codes
• Pre-authorization issues

Carefully review the rejection letter before proceeding.

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Step 2: Gather Required Documents

Before filing an appeal, prepare:

• Insurance policy copy
• Hospital bill
• Discharge summary
• Doctor’s prescription
• Rejection letter

Ensure all documents are clear and legible.

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Step 3: Draft a Formal Appeal Letter

Your appeal letter should include:

1. Policy number
2. Claim number
3. Date of hospitalization
4. Clear explanation of why the claim should be approved

Keep it factual and professional.

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Step 4: Submit Within Timeline

Most insurers allow 15–30 days to appeal.
Submit your documents within the permitted window.

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When to Seek Expert Help

If your claim amount is substantial or repeatedly rejected, consider professional claim assistance.

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Conclusion

Claim rejection is not the end.
With proper documentation and timely action, many appeals are approved successfully.