The #1 Mistake People Make When Refiling a Claim

Introduction

When a claim is denied, the natural reaction is to write an emotional letter explaining how much you need the money or how unfair the situation is. While your feelings are valid, this is the number one mistake people make when refiling.

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The Mistake: Emotional vs. Technical

Insurance adjusters are bound by the Plan Document. They do not have the authority to approve a claim based on sympathy. They can only approve it if it fits the "rules."

The Wrong Way (Emotional)

"I have been a loyal customer for 10 years and this surgery was very expensive. I cannot afford this bill and it is unfair that you aren't paying."

The Right Way (Technical)

"The claim was denied citing Exclusion 4.2. However, per the attached medical records, this procedure falls under the 'Emergency Exception' defined on Page 12 of the Policy Handbook."

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How to Pivot Your Strategy

1. Stop Explaining, Start Quoting: Use the language found in your own Policy Handbook.
2. Use Bullet Points: Adjusters are busy. Use bullets to make your technical arguments easy to scan.
3. Attach Proof: Never make a claim (e.g., "This was an emergency") without an attachment (e.g., "ER Intake Form").

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Conclusion

To win an appeal, you must speak the insurer's language. Swap your emotions for evidence, and your frustration for facts. This shift in strategy is often the difference between a second rejection and a final approval.