Once you've determined that an appeal is right for your situation you will need to:
- Determine the insurer’s appeals process (varies by insurer)
- Submit formal appeal within necessary timeframe as detailed in the appeals process (varies by insurer)
- If the insurer continues to deny the claim, a patient may request an external appeal (the process varies by state law), in which an independent third-party will review the claim and make a final, binding decision.
- Your physician may be able to help you appeal by writing a letter (download a sample) on your behalf, explaining the medical necessity of the service that insurance denied.
- If your health plan is an employer self-funded plan, there are additional appeals processes available. Contact your employer’s human resources department for more detailed information.
Additional resources on appeals:
- Step-by-step guides to the appeals process from Patient Advocate Foundation and The Professional Patient Advocate Institute (PPAI).
- Tips from the Connecticut Healthcare Advocate's office, including how to write an appeal letter.