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WSJ Your Money Briefing

Why Appealing Your Insurance-Claim Denial Could Pay Off

WSJ Your Money Briefing

The Wall Street Journal

News, Business News

3.81.6K Ratings

🗓️ 13 February 2025

⏱️ 9 minutes

🧾️ Download transcript

Summary

Health insurers deny about 850 million claims per year, but less than 1% of patients appeal. Studies show that up to three-quarters of claim appeals are granted. Wall Street Journal reporter Julie Wernau joins host Ariana Aspuru to discuss how patients who fought back won.   Sign up for the WSJ's free Markets A.M. newsletter.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Transcript

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0:00.0

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0:32.8

Here's your money briefing for Thursday, February 13th.

0:36.5

I'm Mariana Aspuru for the Wall Street Journal.

0:40.3

Appealing a medical claim can be an overwhelming process involving complex paperwork,

0:49.3

obtaining letters from doctors, and spending hours on the phone, often during one of the most difficult times

0:55.9

in a person's life. However, studies show that up to three quarters of claim appeals are granted.

1:02.5

It might have been your doctor put in the wrong code or said that they were going to get it

1:07.1

from an out-of-network pharmacy, but it turned out that you could have gotten in-in-network pharmacy, right? There are a lot of things that sometimes are not actually

1:15.6

huge barriers for the insurer. We'll talk with Wall Street Journal reporter Julie Warnow

1:20.0

about how some patients have appealed and won. That's after the break.

1:53.7

Thank you. That's after the break. Health insurance Health insurers deny around 850 million claims per year, according to health policy non-profit KFF. Less than 1% appeal, but a large number of patients who do are successful.

2:03.9

Wall Street Journal reporter Julie Warnow joins me.

2:09.4

Julie, what are some of the reasons why a health insurance company will deny someone's claim?

2:18.8

Health insurance companies might look at someone's claim and say, well, there are some things that are cheaper that they needed to try first, right? So that's often a reason. Sometimes they say, well, there are some things that are cheaper that they needed to try first, right? So that's often a reason. Sometimes they say that they don't actually think that the diagnosis is correct

2:26.8

or that the treatment is appropriate for the patient. And to make these decisions, they're relying on often their own policies,

2:37.8

which are based in lots of studies and research that they've developed for pretty much any

2:44.1

disease you can think of. Walk me through the steps of filing an appeal. If you look at any denial that you get and you read

...

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