What to Do if Your Insurance Denies Coverage
Getting a letter from your insurance company saying your care isn’t covered can feel frustrating, confusing and even a little scary. Here are some steps to consider if your insurance company initially does not allow coverage for your medical care at Baton Rouge General.
Read the Denial Letter Carefully
Your insurance company is required to explain why a claim was denied. Common reasons include:
- Missing paperwork or incorrect coding
- A service being labeled as “not medically necessary”
- Out-of-network providers or facilities
- Pre-authorization not obtained
Call Your Insurance Provider
Pick up the phone and ask for more information. Sometimes a quick call can clear up a misunderstanding or paperwork error. Be sure to:
- Write down the date, time and name of the representative you speak with
- Ask for the denial reason
- Request a copy of your full policy benefits, if you don’t already have it
Connect with Your Doctor
Your doctor’s office can often help provide medical records, letters of support, or re-submit paperwork with the right coding. Ask your physician if they can write a letter explaining why the care is medically necessary.
File an Appeal
Every insurance plan has an appeal process, and you have the right to challenge the denial. There are usually two levels:
- Internal Appeal : You (and your doctor, if helpful) send additional information directly to the insurance company for review.
- External Review: If the denial stands, you can request that an independent, third-party reviewer look at your case.
Get Support
Contact the Louisiana Department of Insurance for free guidance or call us at (225) 819-1000 for help.
Share How Insurance Impacted Your Care
Insurance shouldn’t stand in the way of your health, but for many patients it does with denials, delays and frustrating prior authorizations. If you’ve faced barriers to care due to insurance roadblocks we want to hear from you. Sharing your story can help us show how these challenges affect our community and push for better solutions.