Increasingly, these documents are written in language an average person can follow. You will often find that your claim is covered under the policy for some reason which had not occurred to you. If you don't have these documents, the company must provide them. Request an Explanation and Get it in Writing. Make the call.
Some experts say that up to half of the claims initially rejected are paid upon review.
The Insurance Code requires that the company must give you the basis for the denial of your claim in writing. Demand that they do so and compare the reasons given with the policy or coverage booklet. Often the solution to your problem will become obvious at this point. Many errors are corrected at this stage by, for example, providing a letter from your doctor or other evidence which might cause the claims adjuster to change his or her mind. The company must provide you with any personal information, like lab tests or medical records, they relied on in denying your claim.