How to Appeal Your Health Insurance Company
- 1). Pull out a copy of your health insurance policy and review it carefully. Pay particular attention to the sections that deal with referrals, prior authorization and the use of network and out-of-network providers. You will need to have a thorough understanding of the rules governing your coverage to mount an effective appeal.
- 2). Read the appeal requirements carefully and make sure you understand them completely. It is important to follow the appeal guidelines to the letter. Make sure your appeal goes to the proper address, and make sure that all required information is included on the appeal form.
- 3). Include all of the relevant information in your formal complaint, including what will happen if the claim is denied and why the treatment is necessary. Be sure that your formal complaint also includes complete information from your doctor.
- 4). Make copies of all paperwork for your records. Never send the originals of any documents--always keep the originals in a safe place and send legible copies of all your medical and claim information.
- 5). Follow up in writing after a few weeks have passed without a response. It is fine to call to check on your appeal, but always follow up in writing. If you are following up on a telephone call, be sure to note the time of day you called and the name of the person to whom you spoke.
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