Appeals 101 - Health Insurance and Health Insurance Appeals

Appeals can be won if you research the denial, have familiarity with the appeals process, follow up, be persistent and don't accept the denial as the final result. 

Steps to Appeal a Denial

  1. Step One:  What does the denial mean?   Click here to search your denial.  

  2. Step Two:  Where and when does your appeal need to be sent?  Find the location of where the appeal must go and know the time frame it must be submitted in by reviewing your explanation of benefits, policy booklet or contacting the health plan.

  3. Step Three: You could write your own appeal or purchase one used by actual medical providers.  Appeal letters are affordable, but beware of other websites that may charge a membership fee or expensive attorney fees.  Visit our Appeal Letter Form for free options.

  4. Step Four: After you submit your appeal, follow up if a decision has not been made within 15-30 days.  Confirm that the appeal was received and then ask about its status.  If the denial was upheld, you could resubmit another appeal with new information or ask for a Supervisor or Manager for assistance.

  5. Step Five:  If the denial continues to be upheld, ask for a one time exception or consider filing an insurance complaint with your State's Insurance Commissioner.  When a health plan receives a notice from this department, they react fairly quickly.

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