Appeals Process

Important: Everytime you speak with your insurance company,document the date, time and name of the person with whom you speak along with notes that you take during the conversation.
  • Contact your insurance provider to ensure you have been notified of all specifics associated with your denial.
  • Learn the appeal process from your insurance provider, including when and where the appeals must be sent, as well as what information must be included within an appeal.
  • Request an explanation of benefits or policy booklet from your insurance provider or human resources department.
  • Appeal letters can be purchased by a number of resources or you can write one yourself. If you decide to purchase one, make sure you read all the fine print to understand the total expense involved.
  • Send everything at once. This includes: appeal letter, medical records, letter of medical necessity from your doctor, etc. Keep a complete copy for your records.
  • Send your appeal via certified mail.
  • Follow-up with your insurance provider within 10 business days to ensure they received the package.
  • Confirm with the insurance provider they have on file the correct number of pages submitted.
  • Inquire about the status of the appeal on a regular basis.
  • If the denial is upheld, you can either make another appeal citing a different reason or you can request to speak with someone in management. Many insurance companies have different levels of appeals.
  • If your denial is still upheld, you have several options. These include:contact your human resource department for assistance, hire an attorney or patient advocate, request an exemption with the insurer, contact your State Insurance Commissioner to file an official complaint.