According to data from health-policy nonprofit KFF, insurers process over five billion claims annually, with about 850 million being denied. Surprisingly, less than 1% of patients challenge these denials, even though up to 75% of appeals are successful.

The insurance industry often argues that denials are necessary to maintain financial solvency, only covering treatments that are deemed medically necessary. However, this can be devastating for patients with rare or complex conditions, especially when there is strong medical evidence supporting their treatment.

Fighting a denial can feel overwhelming, requiring patients to handle complicated paperwork, collect medical proof, and spend hours on frustrating calls — all while dealing with health issues.

Fortunately, hospital financial counselors can help by explaining insurance rules, identifying common denial reasons, and guiding patients through appeals. They can help patients understand their options, prepare documentation, and navigate the appeals process more effectively.

Many patients are unaware of how much control they have in these situations. If you or a loved one face a denial, here are some key steps to take:

1. Understand the Denial – Carefully read the insurer’s explanation for the denial and determine the specific reason.
2. Gather Evidence – Obtain medical records, studies, and physician support to back up your claim.
3. Submit a Strong Appeal – Write a compelling letter detailing why the treatment is necessary, including expert opinions.
4. Escalate If Necessary – If your appeal is denied, request an independent external review and involve regulators, policymakers, or the media if needed.
5. Stay Persistent – Many initial denials are overturned simply because patients refuse to back down.

By knowing your rights and taking action, you have a strong chance of getting the coverage you deserve.