FAQ

Our aJust experts are here to help you with 100% of the appeals process. This means that, not only will we help you prepare the appeal letter, but we’ll also take care of the entire fight—from additional paperwork to internal and external reviews. Once you’ve filled out the form and submitted the receipt, you can rest assured knowing your appeal is in our hands.

While both aJust and claim attorneys can help you fight health insurance claim denials, there are some key differences in the way they go about this. A health insurance lawyer may charge a high hourly rate or a hefty fee up front before you know whether or not you will win your appeal. With aJust, you only pay a percentage of your reimbursement once you’ve won your appeal. If the appeal is unsuccessful, there is no cost to you.

Yes. Simply contact us via text or phone so we can understand the specifics of your situation and we can determine how we can help you.

aJust is purpose-built to help Americans fight and win their health insurance appeals. Insurance companies have benefitted from a confusing, complicated, and painful appeal process for far too long. At aJust, we’re experts in how the appeal process works and make sure we file the appeal in a way that maximizes your chances of getting your money back. You can sit back and
relax while we do the dirty work of fighting your denial.

Plus, because you usually have just one shot at getting your appeal right, it’s important to set your case up for success. At aJust, we make sure your appeal is handled the correct way in order to save you money.

In short, no. Your health insurer may allow unlimited appeals for their appeal; however, you are often permitted only one appeal for external appeals.

For internal appeals, your health insurance company must respond / make a decision within 60 days if it’s an appeal for a service you have already received. If you have yet to receive the service and it’s a pre-authorized denial, your health insurance company must make a decision within 30 days.

For external appeals, decisions are typically made within 45 days of receiving the request. In some cases you may be able to expedite the external review and receive an answer in less than 72 hours.

While the process of fighting a medical claim denial varies from state to state, here are the basic steps you may follow:

• Find out why the claim was denied. (You should receive an explanation in the mail, or may call your insurance provider to discover the reason.)
• Go over your plan policy (Once you have an explanation for the denial, you may want to check it against the terms of your health insurance plan to make sure the terms were not violated.)
• File an internal appeal (If you believe your claim has been wrongfully denied, you can ask to file an internal appeal with your health insurance provider. This process differs from company to company.)
• File an external appeal (If you have been unsuccessful with an internal appeal, you can take your appeal to a third-party reviewer. Many states offer external reviews, as does the federal government’s Department of Health and Human Services)

Fighting an insurance claim denial can be a time-consuming and exhausting process, especially if you are handling it alone. That’s why using aJust’s services can take the burden off your shoulders while also setting you up for success.

There are a variety of reasons, but ultimately with a medical claim denial, the health insurer is stating that the service an individual received does not fall under the health insurance plan. Here are a few reasons why a health insurance provider would determine they are not responsible for paying the claim:

• Prior Authorization Was Required: At times, a claim may be denied because prior authorization from the insurance provider was required but the request was not submitted before the service was received.
• Missing or Incorrect Information: Mistakes happen! But when there are errors in a claim form—such as a misspelled name or missing piece of paperwork—a denial is likely. That is why it is important to double and even triple check information on your claim form and make sure that is it is filled out completely if you are the one submitting it.
• Outdated Insurance Information: Claims can be denied due to outdated insurance information, such as sending the claim to the wrong insurance company.
• Claim Was Filed Too Late: Most insurance companies have a window of time (6 months to 1 year) where they will accept claims. If you wait too long and miss the window, your claim is likely to be denied.
• Services Not Covered: There can be exclusions to your plan and some procedures may not be covered by your policy, or there may be a limitation to the number of visits for a particular service.

Sometimes, certain health services require your health insurance provider to approve or deny responsibility before the healthcare service has been provided. This is called a pre-authorization or prior authorization. You are able to fight a pre-authorization denial as well as a regular denial.

A health insurance claim denial is when your health insurer declares they are not responsible for paying / reimbursing for the care that has already been provided. The responsibility to pay the medical bill is then shifted back to you.

A health insurance claim is a request submitted to your health insurance provider – typically by your health care provider but sometimes by you – that seeks reimbursement for the cost of the care received.

For example, if you go to your family doctor for an annual check-up that involves a blood test and hearing exam, your doctor’s office will submit a list of costs to your insurance company for each service that was provided. Your insurance provider will then determine what percentage of the costs you will be responsible for based on the co-pay, deductible, out of pocket maximum, and coverage of your plan. They will then pay the rest of the claim bill.

When you submit a photo or a scan of a receipt or any document (e.g. explanation of benefits), the file should be less than 5 MB. Most file types are accepted: JPEG/JPG, PDF, PNG, TIFF.

No. There are no limits.

Yes, aJust will handle an appeal of a denial of a prior authorization request. The process is similar to that for handling a denied claim but does require more work with your doctor to document your condition and reasons for the requested treatment.

No. At this time aJust only handles claims for health insurance for humans.

Most insurance providers require that initial claims be filed within 1 year of the date of service.

Most insurance providers require that appeals be filed with 30-60 days after the claim is denied.

Most state review boards require that appeals be filed with 30-60 days after the appeal is denied by your insurance provider.

Denied claims will have to be appealed to your insurance provider first. If that is denied, then a separate appeal must be filed with your state insurance review board. Most insurance providers will provide a response within 30-45 days. State review boards generally respond within 30-60 days.

There are a lot of variables that come into play to determine the potential reimbursement of any claim: the type of claim, what stage you are at in the process (appealing to insurance provider or state), reason for the denial, coverage information (deductibles, coinsurance, etc.), exclusions, whether it’s a state or federally governed plan. Unfortunately, no one has a crystal ball and we cannot win every claim but our experience shows that we can get reimbursement for the majority of denied claims that we handle.

All of your data is encrypted at all steps in the process and aJust follows HIPAA- compliant guidelines and industry best practices to help ensure your personal data is confidential and secure.

We will file the claim or appeal as soon as we get all the information that we need.

In order to represent you with your insurance provider, we will need your basic information (name, email, contact info) plus a copy of your insurance card (front and back), and copies of any correspondence with your insurance provider and your medical receipts.