Why did insurance *really* deny your claim?

When insurance denies your claim, they’ll give you an official reason — but what were they really thinking?

Turns out, you have a right to know. To see their notes, maybe even their internal correspondence, or to listen to audio recordings from phone calls. It’s all in your “claim file,” which federal law says you have the right to demand.

What’s in that file could definitely help you fight back.

And an easy-to-use tool from journalists at ProPublica makes it much simpler to demand what’s yours. It’s called Claim File Helper.

“With a lot of health insurance paperwork, it can feel exhausting and tedious,” says ProPublica engagement reporter Maya Miller, who helped create the tool. “We tried to design something that was low-lift and wouldn’t take a lot of time.”

She says more than 1,000 people have used Claim File Helper so far, and she’s heard from users who won appeals by using the information they received.

She says at least a few people got results more easily than they — or she — would have expected.

“We’ve heard from people who submitted the claim file request, and the insurance company apparently thought it was an appeal — and they overturned the denial,” she says.

Not everybody gets those kinds of results. Miller says she’s heard from people who never even received their file.

But it’s worth a shot — and in the process, you could also help Miller and her colleagues with their ongoing investigations into how insurance denies people coverage, and what we can maybe do about it.

The whole investigation — including the Claim File Helper — has been powered by public input.

Collaboration with readers

ProPublica’s team learned about our rights to these records after asking readers to share their experiences with insurance denials.

One person who responded, Lee Mazurek, told them he’d actually been tipped off by an insurance-company case manager while appealing a denial.

“I was like, I had no idea you could request your file,” Miller says. “It was really exciting for us. We were like: Now we can see what’s going on under the hood at insurance companies.”

The team published a story based in part on Mazurek’s experience — with instructions on how readers could request their own files, and an invitation to share their experiences.

After hearing from “a lot of people getting stonewalled” when they requested their claim files, Miller and her colleagues published a follow-up story and the Claim File Helper tool, hoping to make it easier for people to enforce their rights.

Putting the tool to use and helping each other

The form at Claim File Helper is simple: If you’ve got your denial letter handy, it’ll take just a couple minutes — and the site generates a PDF with an official-looking request letter, ready to print out and send.

It’s also got clear, helpful instructions for what to do next.

Briefly: You’ll need to gather some documents and make copies — hang on to the originals — and send them by U.S. mail or fax. (Patient advocates suggest sending certified mail so you have proof of delivery.)

If you choose to share your information with ProPublica (which is totally optional), you’ll be helping them with their investigation, and you’ll help them keep refining the tool.

And you could get some help yourself. For one thing, if your insurance company hasn’t responded to your request within 30 days, they’re blowing a legal deadline, and ProPublica will email you a reminder to bug them.

You might also get a call from Miller or one of her colleagues. They’ll be interested to learn from you — and they may have helpful tips.

“We can’t give legal advice,” she says. “We’re not lawyers.” But they can pass along stories about what other people have done. “We can say, ‘This has worked for other people in the past…’”

The tool won’t work for everyone. When I test-drove it, a message appeared letting me know that it might not work for people on Medicare. But if you have private insurance, make sure to save this link somewhere you can find it.

Use that paper trail to draft your winning appeal

Once you get your hands on the claim file, the work of digging through the documents begins.

Miller suggests checking for simple mistakes: ProPublica has highlighted instances of insurers denying treatment based on applying the wrong set of medical guidelines or because they misread the type of surgery the patient needed.

When you’re ready to start writing your appeal, check out our Starter Pack on dealing with insurance denials — including advice from someone who’s practically a master at writing appeals.

Finally, this deadline to make your voice heard is tomorrow

Last week, we wrote about news that might have slipped by you: proposed federal rule changes that would allow — and push — Obamacare plans with deductibles of more than $31,000.

The Trump administration has quietly proposed these and other sweeping changes, with only a brief period for public comment.

Over 90 of you clicked the link to share a public comment on this plan last week. We LOVE that enthusiasm! And we want to make sure as many of you as possible can chime in.

So if you haven’t yet, please fill out this form and share the link around! You have until tomorrow, Friday, March 13, at 11:59 pm EST.

That’s all from me — see you in your inbox next week!

— Claire