Now that your doctor has exhausted all of his or her pre-determination request appeals, what can you do? You, as the patient, have the right to appeal the denial(s) and you should pursue this option. Some patients have been successful in getting their insurance company to pay for their treatment using the appeals process. You will need to work closely with your doctor to pull together a compelling request with supporting medical information to appeal the denial(s).
Most health plans have a patient appeals process. Contact your health plan for details about the patient appeals process. Here are some important items to ask about:
It’s very important to find out right away what is your insurance company’s deadline for filing the patient appeal. Most states mandate the timeframe in which patient appeals must be processed. Your insurance company can tell you what that timeframe is. Make sure to submit your appeal before the deadline. Once you file your appeal, the health plan must respond to you within a specific time period.
Consider sending the appeal letter and supporting paperwork by certified mail and request a confirmation of receipt. Alternatively, you may call the insurance company to confirm receipt. Make a copy of what you submitted for your records. If you make any phone calls to the insurance company, document the date, who you spoke with and a summary of the conversation.