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FAQs |
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FAQs |
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Forms & |
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Documents |
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Insurance Overview |
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CORE Hotline |
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Patient Assistance |
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Program |
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Glossary |
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| The Appeals Process | FAQs |
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Why did my insurance deny my coverage?
What is an appeal?
How long does my insurance plan have to respond to an appeal request?
What is an "external review"?
Are external reviews available in every state?
Are external reviews available for every type of health insurance plan?
When can I request an external review from my health insurance plan?
Q: Why did my insurance deny my coverage?
A: There are many reasons why insurance plans issue denials. It could be that a prior authorization was not initiated with your insurance plan. The plan may also deny the request due to lack of medical documentation to support treatment. Whatever the reason, you may be able to file an appeal. See Appeals for an example of how the process works.
Q: What is an appeal?
A: An appeal is a request for reconsideration of services that were denied reimbursement by an insurance plan. An appeal is filed if the insurance plan does not pay or does not pay enough for a procedure or service. The appeal is made to the insurance plan and there are usually specific guidelines.
Q: How long does my insurance plan have to respond to an appeal request?
A: The amount of time varies by plan, but insurance plans usually have 30 to 45 days to respond to an appeal request.
Q: What is an "external review"?
A: This is when an outside independent party examines the denied services. An external review provides an impartial expert opinion regarding the medical necessity of your treatment.
Q: Are external reviews available in every state?
A: Approximately forty states and the District of Columbia have adopted external review laws.
Q: Are external reviews available for every type of health insurance plan?
A: External review laws vary by state. Each state has different allowances for the types of health insurance.
Q: When can I request an external review from my health insurance plan?
A: Usually, you can only request an external review after your plan's internal appeal process has been completed. Your insurance company can provide more information.
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