If you have been paying your health insurance premiums, your health insurance provider is legally obligated by contract law to make good on benefits covered by its policy. All health insurance policies have exclusions, and no policy covers everything. Generally the insurer's obligations are clearly defined in the policy. Insurance companies can, however, require documentation before paying claims. If you believe you have been unfairly denied an emergency room insurance claim, you can appeal the decision within the company and to state regulators.
Instructions
1. Gather documents. Get a copy of the emergency room attending physician's notes and statements, as well as any records from the ambulance service, paramedics or police, if applicable.
2. Ask the physician for a letter verifying the treatment provided was medically necessary and for a bona fide emergency. This latter stipulation may be important to justify any added expenses if you went out of network for the emergency treatment. If you have a primary care physician, he may be able to assist you with a letter as well.
3. Appeal to the claims director for your insurance company. Frequently this individual is a physician as well. Check your policy for specifics on where to address your appeal. Include a copy of all your emergency treatment records as well as any relevant details from your personal medical history that support your claim. Include copies of your bills.
4. Appeal to your state insurance commissioner. You can find contact information via the link to the National Association of Insurance Commissioners (see "Resources").
