Don’t Let Denied Healthcare Claims Go Unchallenged

Navigating the healthcare system can be complicated, and one of the biggest challenges employees face is what to do when a healthcare claim is denied. Unfortunately, most employees are left in the dark, unsure of how to appeal or even that they can appeal. The result? Too many claims go unchallenged, even when they shouldn’t.

Research shows denials aren’t always valid. According to The Leukemia & Lymphoma Society, many denied claims aren’t sufficiently reviewed by insurers before being rejected. However, since appeals are so rare, these mistakes often go unchecked.

Why Employees Don’t Appeal Denied Claims

According to the U.S. Department of Labor's ERISA Advisory Council, there are several reasons why participants fail to appeal denied healthcare claims:

• The appeals process is overly complicated. Most employees don’t understand how the system works. Healthcare jargon, complex forms, and bureaucratic roadblocks make the process feel impossible for the average person.
• Many employees don’t know they can appeal. It’s not widely known that appealing a claim denial is even an option. Even those who are aware often feel overwhelmed and lack the confidence to start the process.
• Insurers don’t make it easy. In many cases, insurance companies provide little to no guidance on how to appeal, leaving participants in the dark. There are also financial incentives for insurers to keep appeals low, which means they may not always encourage or support the process.
• Attorneys complicate the situation. Some employees who attempt to appeal run into attorneys working on contingency fees, adding a layer of complexity that can be intimidating or feel like an unnecessary barrier to what should be a simple, straightforward process.

The Solution? Educate Your Employees

You can wait for the healthcare system to fix itself (spoiler: that’s not happening anytime soon), or you can take proactive steps to empower your employees to take control when their healthcare claims are denied. Here’s why that’s the smarter choice:

1. Knowledge is power. When employees know how the appeals process works, they’re more likely to take action. A simple educational session or guide can make all the difference.
2. Boost employee confidence. By offering training or resources, you can help your employees feel more confident in navigating the appeals process, ensuring they aren’t leaving money on the table.
3. Reduce unnecessary out-of-pocket costs. When employees don’t appeal valid claims, they may end up paying out-of-pocket for services that should have been covered. Educating them on how to handle denials could save them significant costs—and lower their stress.
4. Improve employee satisfaction. Employees who feel supported and informed about their healthcare benefits are more satisfied and loyal.

How to Start Educating Your Team

• Provide simple guides. Create easy-to-understand resources that break down the appeals process in plain language.
• Host training sessions. Hold workshops or webinars to walk employees through the steps of appealing a denied claim.
• Offer ongoing support. Ensure HR, your benefits administrator, or your advisor is available to help employees who need assistance with a denied claim. Having someone to guide them through the process can make it feel much more manageable.

Final Thoughts

By taking the initiative to educate your employees on appealing denied healthcare claims, you can help them navigate a system that is often confusing and frustrating. With the right knowledge, they’ll be better equipped to fight for the coverage they deserve—saving them money and reducing stress.

In the end, it’s a win-win for both your employees and your organization.

Need help building an effective claims support system? Let's talk. Schedule a 15-minute call with our benefits team to explore solutions for your company:

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