Life Kit

What to do when your health insurance denies coverage

September 18, 2025

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  • Preventative care services are legally mandated to be covered by health insurance plans without out-of-pocket costs under federal law, but appeals are often necessary due to billing errors or coding mistakes. 
  • If an insurance claim for preventative care is denied, patients have the right to appeal internally and, if unsuccessful, pursue an external medical review by an independent professional. 
  • Even after exhausting insurance appeals, options like negotiating medical bills with providers, applying for hospital financial assistance, or utilizing employer HR departments can help manage costs. 

Segments

Understanding Preventative Care
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(00:00:17)
  • Key Takeaway: Preventative care services, as defined by federal law, are generally covered by insurance without out-of-pocket costs, but eligibility can vary based on age, gender, and health history.
  • Summary: This segment introduces the concept of preventative care, lists common examples like annual physicals and screenings, and explains that while most are covered, individual circumstances can affect eligibility.
Appealing Insurance Denials
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(00:07:09)
  • Key Takeaway: Patients should not accept the first denial from an insurance company as final, as appeals are often successful and require documentation to build a case.
  • Summary: The discussion focuses on what to do when an insurance company denies coverage for a preventative service, emphasizing the importance of understanding the denial reason, filing an internal appeal with supporting evidence, and not panicking.
External Review and Further Options
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(00:14:53)
  • Key Takeaway: If internal appeals are exhausted, an external medical review by an independent professional offers a legally binding decision, and further options include negotiating bills or seeking financial assistance.
  • Summary: This segment covers the process of requesting an external medical review, its high success rate, and alternative strategies like negotiating with providers or applying for financial aid if the claim is ultimately denied.
Employer and Provider Engagement
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(00:19:38)
  • Key Takeaway: Engaging with an employer’s HR department or directly with medical billing offices can provide additional avenues for resolving insurance disputes and managing medical debt.
  • Summary: The conversation explores how HR departments can intervene in insurance disputes and advises on how to negotiate with medical billing offices, including asking for discounts or setting up payment plans, while cautioning against using credit cards for medical debt.