# What to do when your insurance denies a claim?

**URL:** <https://boards.straightdope.com/t/what-to-do-when-your-insurance-denies-a-claim/566692>\
**Category:** In My Humble Opinion\
**Created:** [January 7, 2011, 1:06am UTC](https://boards.straightdope.com/t/what-to-do-when-your-insurance-denies-a-claim/566692 "2011-01-07T01:06:27Z")\
**Posts on this page:** 5\
**Page:** 2

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**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\
**Post date:** [January 9, 2011, 4:36am UTC](https://boards.straightdope.com/t/what-to-do-when-your-insurance-denies-a-claim/566692/21 "2011-01-09T04:36:34Z")

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> [@NinetyWt](#):
>
> I dunno. I went to the hospital for an emergency appendectomy three years ago. The insurance company refused to pay as it was an out-of-network hospital. I appealed it and they refused again.
> 
> I am still paying on that bill.

There’s no Insurance Commissioner( or similar) in your state? That’s sounds absolutely like an emergency.

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**Author:** ![NinetyWt](https://avatars.discourse-cdn.com/v4/letter/n/cc9497/32.png) [@NinetyWt](https://boards.straightdope.com/u/NinetyWt)\
**Post date:** [January 9, 2011, 4:52am UTC](https://boards.straightdope.com/t/what-to-do-when-your-insurance-denies-a-claim/566692/22 "2011-01-09T04:52:35Z")

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I even asked the doctor to write a letter, expressly stating that it was an emergency and I was not in any state of mind to be looking up in-network hospitals. It didn’t help.

I didn’t think about the Commissioner though. Hmm.

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**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\
**Post date:** [January 9, 2011, 4:58am UTC](https://boards.straightdope.com/t/what-to-do-when-your-insurance-denies-a-claim/566692/23 "2011-01-09T04:58:23Z")

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What was the reason given for the refusal?  
Was a in-network hospital close enough to be an option in the eyes of the insurance company?

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**Author:** ![NinetyWt](https://avatars.discourse-cdn.com/v4/letter/n/cc9497/32.png) [@NinetyWt](https://boards.straightdope.com/u/NinetyWt)\
**Post date:** [January 9, 2011, 5:01am UTC](https://boards.straightdope.com/t/what-to-do-when-your-insurance-denies-a-claim/566692/24 "2011-01-09T05:01:45Z")

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IIRC it just said “out of network”. Probably they thought I should have gone to the correct one. There are about a half-dozen of them nested up in the same few blocks downtown.

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<div class="post-metadata">

**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\
**Post date:** [January 9, 2011, 5:08am UTC](https://boards.straightdope.com/t/what-to-do-when-your-insurance-denies-a-claim/566692/25 "2011-01-09T05:08:52Z")

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> [@NinetyWt](#):
>
> IIRC it just said “out of network”. Probably they thought I should have gone to the correct one. There are about a half-dozen of them nested up in the same few blocks downtown.

Unfortunately, if the hospitals were that close, they probably have standing to refuse. If you had been unconscious, it would have most likely been different.

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