Insurance claim denied: what to do

Have this ready

• denial letter
• policy
• claim number
• bills
• photos
• medical records for health claims

Steps for any company

1. Ask for the denial reason and the policy language in writing.

2. File an internal appeal within the deadline in the denial letter.

3. After the internal appeal, ask for external review (health) or complain to the state insurance department.

A company playbook below replaces these generic steps with the company’s own forms, phone numbers and deadlines.

Company playbooks (19)

Auto, home and renters insurance

• AllstateRaise the disagreement with the claim representative, then demand appraisal for an amount dispute, then complain to the state.
• American Family InsuranceAsk the adjuster for the reason in writing, then file with Consumer Affairs and the state insurance department.
• Farmers InsuranceRead the claim letters in the portal, dispute with the claims representative, then write to Farmers and the state insurance department.
• GEICODispute with the adjuster in writing, ask for a re-evaluation with evidence, then appraisal and the state insurance department.
• Liberty MutualAsk for the itemized valuation, dispute in writing, use appraisal for an amount dispute, then complain to the state.
• NationwideAsk the claims associate for the reason in writing, then take it to the Office of Customer Relations and the state.
• ProgressiveAsk the claims rep for the reason and the valuation in writing, send counter-evidence, then complain to the state.
• State FarmGet the written denial with the policy language, dispute it with the claim handler, then go to the state insurance department.
• TravelersAsk the Claim professional for the reason and valuation, then complain to Consumer Affairs and the state insurance department.

Health insurance

• AetnaAppeal within 180 days at the address on the EOB or online, ask for an urgent appeal if health is at risk, then external review.
• Anthem (Elevance Health)Read the EOB and denial letter, file the internal appeal at the address on the letter, then ask for external review or complain to the state or Medicare.
• Blue Cross Blue Shield (BCBS Association and FEP Blue)Appeal with your local Blue plan (address on the EOB). FEP members ask the Local Plan to reconsider within 6 months, then ask OPM.
• Centene (Ambetter, Wellcare, Health Net)Appeal to your Ambetter state plan within 180 days of the denial notice, then ask for external review.
• Cigna HealthcareCall customer service, then file a written appeal with the medical appeal form, then ask for external review.
• HumanaAppeal within 65 days of the Medicare denial notice, online, by mail or fax, or by phone for expedited cases.
• Kaiser PermanenteRead the EOB for appeal steps, file a grievance or appeal, track it online, then go to the state regulator.
• Molina HealthcareAppeal to your state Molina plan within 180 days of the denial notice, then ask for external review (Marketplace) or a State Fair Hearing (Medicaid).
• Oscar HealthAsk the Care Team for the reason, file a grievance or appeal, then ask for external review through the state.
• UnitedHealthcareAppeal within 180 days of the denial (most plans) online or by mail, then ask for external review. Medicare Advantage members have 65 days.

Guides

• Auto, home and renters insurance — how complaints work
• Health insurance — how complaints work