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Tips on Appealing Your Health Insurance Coverage Denials

1. If you are denied the right to get a procedure or treatment or use a drug, call your insurance company immediately.
2. Find out why your claim was denied.
3. Find out how the appeals process works.
4. Make sure you write down the name and extension number of the person you spoke with, and take notes during the call.
5. If your denial cannot be easily resolved, ask the insurer for some key documents, such as, denial letter, a copy of your  plan’s full benefits, the company’s medical policies, etc.
6. Draft an appeal letter and send it via certified mail.
7. When writing your appeal letter, indicate the date, claim number, date of service, your member identification (subscriber) number, group or policy number, amount of charge, medical provider name and then describe the denial, why you are writing, and what you are requesting.
8. Include supporting documents such as letter of medical necessity from your doctor, medical records, pathology reports, etc.
9. As a last resort you can hire a lawyer.
10. Do not give up!

Online Resources:

• You can contact Georgia Insurance Commissioners Office 404-656-2070
• Kaiser Family Foundation provides an in-depth explanation on how to appeal
• Patient Advocate has a step by step guide on the appeals process