An insurance appeal will require work on your part, and likely some work on our part as well. Any work on our part will be billed at the regular hourly rate.
Information your insurer should provide to you when denying a claim:
- A statement of specific medical and scientific reason for denial.
- A statement identifying the provision that excludes treatment.
- The name, state of licensing, medical license number, and title of the person making the denial decision.
- A description of alternative treatment, services, or supplies that are covered, if any.
- Instructions for initiating internal appeals of denial, including whether your appeal has to be in writing, time limits, schedules for filing, and the name and phone number of a contact person.
- Instructions for filing an external request for review if the denial is upheld in the internal review.
If you do not receive this information from the insurer, ask for it in writing.
(Source: State departments of insurance)
Parent letter of appeal – first level appeal
Parent letter of appeal – second level appeal
Parent letter of appeal – based on ‘not medically necessary’
