Quantcast
Get breaking news alerts via email

Click here to manage your alerts
4 keys to appealing a rejected insurance claim


< Previous Page


Make sure you directly address the insurer’s reason for denying coverage. Not doing so is the biggest mistake people make in filing appeals, according to Cheryl Fish-Parcham, private insurance program director for the health advocacy group Families USA.

Submit your appeals by certified mail so you can document when the insurer receives them and that you met any specified deadlines.

Join the Discussion
Post a Comment

Be persistent. If the first appeal doesn’t work, the insurer should outline additional options that may include an appeal to a medical director who was not involved in the decision.

The insurer also may permit a peer-to-peer review, in which your doctor talks to a physician representing the insurer about your case.

3. GOING OUTSIDE THE INSURER

If you’re not happy with the insurer’s internal review, seek an examination from an independent reviewer. Be mindful of any deadlines for making such a request.

Some patients with employer-sponsored health plans also may be able to turn to their company for help. Companies with self-funded coverage — largely those with 200 or more workers — actually pay the medical bills and hire insurers to administer their plans.

The employer may learn through your appeal that its coverage is more limited than what company leaders intended, said Erin Moaratty, chief of mission delivery for the Patient Advocate Foundation, a nonprofit organization that helps patients with medical bills and coverage denials.

Even if the employer declines to overturn the insurer’s decision, it can be important for companies to be brought into the appeals conversation so that they can consider making coverage adjustments over time.

Check with your human resources department to see if your coverage is self-funded and if they can help you understand the appeals process or put you in touch with the right insurance representative.


story continues below
story continues below

4. SEEKING HELP

If you’re not comfortable shaping your argument, or you’re not physically up to it, you have a few options for outside help. Some states offer consumer assistance programs, and your insurer should provide you with contact information for the program in your state.

Help is also available from nonprofit agencies like Patient Advocate Foundation and The Jennifer Jaff Center, which can assist with appeals in cases involving chronic, life-threatening or debilitating illnesses.

For-profit companies like Medical Billing Advocates of America also work on insurance denials. A spokeswoman said its fees depend on the amount of time spent working on the case.



Copyright 2014 The Salt Lake Tribune. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Top Reader Comments Read All Comments Post a Comment
Click here to read all comments   Click here to post a comment


About Reader Comments


Reader comments on sltrib.com are the opinions of the writer, not The Salt Lake Tribune. We will delete comments containing obscenities, personal attacks and inappropriate or offensive remarks. Flagrant or repeat violators will be banned. If you see an objectionable comment, please alert us by clicking the arrow on the upper right side of the comment and selecting "Flag comment as inappropriate". If you've recently registered with Disqus or aren't seeing your comments immediately, you may need to verify your email address. To do so, visit disqus.com/account.
See more about comments here.
Staying Connected
Videos
Jobs
Contests and Promotions
  • Search Obituaries
  • Place an Obituary

  • Search Cars
  • Search Homes
  • Search Jobs
  • Search Marketplace
  • Search Legal Notices

  • Other Services
  • Advertise With Us
  • Subscribe to the Newspaper
  • Access your e-Edition
  • Frequently Asked Questions
  • Contact a newsroom staff member
  • Access the Trib Archives
  • Privacy Policy
  • Missing your paper? Need to place your paper on vacation hold? For this and any other subscription related needs, click here or call 801.204.6100.