What to do When Your Health Insurance Refuses to Pay

What to Do When Your Health Insurance Refuses to Pay

When your health insurance denies or delays a claim, it can feel like a gut-punch. At RedStone Law, we help injured clients in Kentucky and Tennessee navigate these frustrating situations and pursue the medical coverage they deserve.
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why your claim might be denied

• The service isn’t covered under your plan – Review your policy thoroughly.
• The provider didn’t obtain pre-authorization when required.
• The treatment was labeled “not medically necessary” – Ask your physician for a written statement explaining why it was.
• You used an out-of-network provider or services were submitted incorrectly.
• A coding or billing error occurred, or another policy (like auto or workers’ comp) should have paid first.

steps to challenge the denial

1. Contact your insurer immediately and request a detailed explanation of the denial reason and instructions for filing an appeal.
2. Write a formal appeal letter that includes:
   • A brief explanation of why the treatment was necessary.
   • Specific language from your policy supporting coverage.
   • Physician’s statement on medical necessity or lack of pre-authorization opportunity.
   • Attach supporting medical records, bills, and communications.
   • Keep a detailed log of all conversations (date, person spoken with, summary).
3. Keep accurate records — every call, email, and piece of documentation (billing codes, service dates, physician notes) can be crucial.
4. If your internal appeal is denied, you may have the right to an external review via your state’s insurance commissioner or independent review board.

When You Should Get Legal Help

If the amount of unpaid medical bills is large, or if you’re being told you have no other remedy — don’t assume you’re out of options. At RedStone Law, our experienced injury attorneys can evaluate whether there are legal grounds for recovery based on your case and policy.

reach out for a free consultation

We offer a no-cost, no-pressure consultation to review your insurance denial and explain your rights. Let our team help you take the next step toward recovery.