How To Appeal a Health Insurance Decision

  • February 4, 2010
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Occasionally, your health insurance claim may be denied. Paperwork and persistence are crucial to reversing your carrier’s decision.

You Will Need

  • Help from your doctor
  • Medical paperwork
  • Persistance
  • A computer with internet access (optional)
How To Appeal a Health Insurance Decision: Enlist doctor’s aid

Step 1: Enlist doctor’s aid

Enlist your doctor’s assistance with correct coding information, proper documentation, and medical records.

How To Appeal a Health Insurance Decision: Write appeal letter

Step 2: Write appeal letter

Write your appeal letter. Be sure to include the date, claim number, date of service, policy number, reason for denial, why you are writing, and what you are requesting.

Sample medical appeal letters are available online.

How To Appeal a Health Insurance Decision: Include paperwork

Step 3: Include paperwork

Include supporting paperwork with your appeal letter such as letters of medical necessity from your physician and medical records.

How To Appeal a Health Insurance Decision: Identify address

Step 4: Identify address

Identify the address where you will need to send your appeal. It may be different than the claim submission address.

How To Appeal a Health Insurance Decision: Send certified mail

Step 5: Send certified mail

Send via certified mail. The return receipt will ensure that your appeal is received.

Did you know? The first U.S. health insurance plans began during the Civil War and offered coverage of rail- or steamboat-related travel accidents.

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