From ProPublica: Health Insurance Claim Denied? See What Insurers Said Behind the Scenes

Some good advise: 

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When a health insurance company is deciding whether to pay for your medical treatment, the company generates a file around your claim. All the records associated with your case should be part of your file. This includes documents explaining the reasons your claim was denied.

You have a right to see this file. Federal regulations require most health insurance plans to give people an opportunity to review documents related to their claim for free. So if your insurer talks to your doctor, if a nurse takes notes, or if two people speak about it on the phone, all of those records should be available to you.

“It’s a treasure trove of information,” said Juliette Forstenzer Espinosa, a health lawyer and senior lecturer of health policy at George Washington University. “But most people have no idea how to get it.”

Health insurers rarely advertise that people can access their claim files, Espinosa said. Where guidance exists, it is often embedded deep in denial letters. Few offer templates or even give instructions on their websites.

Patients who make it through the records request process get information that can be revelatory. Some told us they received case notes exposing how they had been funneled into programs the health insurance company deployed to cut costs. A few obtained audio recordings of phone calls showing company staff introducing errors into their cases.

And others, such as former Cigna patient Lee Mazurek, found out exactly how much companies projected saving on their cases. Mazurek had been on a treatment regimen for nearly nine years that was keeping his Crohn’s disease at bay. Changing it, a Cigna employee estimated, could save more than $98,000. (Cigna spokesperson Justine Sessions said the insurer only suggests changes when clinically appropriate and that cost is never the sole determining factor. She said Cigna does not directly benefit from such savings.)

Taken together, these documents can offer a window into the opaque system of health insurance denials. Details in them have helped us report on some of the country’s largest insurance companies and their attempts to cut costs at the expense of patient well-being.

We have spoken with patients, health care providers, former and current health insurance employees and health policy experts to better understand how people facing denials can request their information. We believe it is important to share with our readers what we are learning about this process. To that end, we have collected advice on requesting your claim file and answers to common questions you may have, including a template you can use to get your request started.