- Step 1: Review paperwork Review your paperwork and carefully examine your statement of benefits.
- Step 2: Contact your insurance company Contact your insurance company's customer or member services department for help resolving the issue, or for a clarification of your benefits.
- TIP: Keep copies of all correspondence and relevant documents, as well as detailed notes from any phone conversations.
- Step 3: Prepare to file an appeal Familiarize yourself with your insurance company's requirements for filing a first-step appeal, also known as a grievance, if the member services representative does not provide a satisfactory resolution to your issue.
- Step 4: Write an appeal letter Write an appeal letter to your insurance company. If the dispute is over a "usual and customary" or out-of-network denial, address the methodologies used to calculate usual and customary fees, and any extenuating circumstances that would justify a higher payment.
- TIP: Consider purchasing an appeal letter if you are not comfortable writing your own. Some websites offer health insurance appeal letters for a fee.
- Step 5: Wait for a decision Wait for a decision from the insurance company. If your appeal is denied, you may have the option of further appeals. Check your benefits statement.
- Step 6: File an external appeal Apply for an external appeal once all of your internal appeals are exhausted. You may be able to request an independent review of your dispute from your state's insurance commissioner -- note that rules vary from state to state. Keep trying until your options are exhausted -- or until your insurance agrees to cover the charge.
- FACT: Dental insurance had its beginnings in the 1970s.
You Will Need
- Paperwork and a statement of benefits
- Internet access
- External appeal
- Correspondence (optional)
- Phone conversation notes (optional)