How do I appeal a coverage decision made by my health insurer?
If your health insurer denies a claim and refuses to pay for your care or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party.
Insurers are required to let you know why they denied your claim or ended your coverage. They are also required to tell you how you can dispute their decision.
There are two types of appeals:
- Internal appeals, which allow you to request that your health plan conduct a thorough and fair review of their denial of coverage for your claim.
- External appeals, which allow you to request that a third-party review your health plan’s decision to deny coverage of your claim. You can file for an external appeal if, after an internal review, your health plan still denies your claim.
Find more information on the types of denials that can be appealed and what you should expect during the internal and external review processes here.
If you need help filing an appeal contact the Consumer Assistance Program in your state.
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