🧾 Seven Sentences to Use When an Insurance Claim Is Denied

📣 Health insurance denials can leave families facing bills they did not expect, and many residents in the Dunlap area and across the Sequatchie Valley may never have been told what questions to ask. A flyer shared on the Facebook page of Mountain Side Recovery, a Dayton, Tennessee business in Rhea County, offers a short checklist of phrases for people who want a denied claim reviewed.

📋 What the Flyer Recommends

The flyer, titled “7 Sentences That Kill a Denied Insurance Claim,” lists seven statements a patient or family member might say or write to an insurer. Each one targets a specific step in the appeal process:

1️⃣ Request the reason in writing: “Send me the denial in writing, with the exact reason.”

2️⃣ Ask for the criteria: “Which medical criteria did you use to deny this?”

3️⃣ Start an internal appeal and confirm the deadline: “I’m filing an internal appeal. Confirm my deadline in writing.”

4️⃣ Request a peer-to-peer review: “I want a peer-to-peer review between my doctor and your medical director.”

5️⃣ Ask for the full claim file: “Send me my complete claim file. I’m entitled to it.”

6️⃣ Request an independent external review: “If you uphold the denial, I’m requesting an independent external review.”

7️⃣ Escalate to the state: “If this isn’t fixed, I’m filing a complaint with my state insurance department.”

💡 Why It Matters Locally

❤️ For families in smaller communities, a denied claim can be stressful and confusing, especially when the paperwork is dense and the timeline is unclear. A written checklist gives people a starting point for asking direct questions and keeping a record of their requests. The flyer’s final line, “Save this. You’ll need it,” suggests it is meant to be kept on hand for future reference.

📝 The flyer does not explain how each appeal process works in detail, and it does not describe specific insurance plans or deadlines. Readers who receive a denial should review their own policy documents and contact their insurer or state insurance department for guidance specific to their situation.