How to Appeal a Health Insurance Denial

If You Receive a Denial from Your Health Insurance Company, You Can Appeal It.

You Can Appeal Coverage Denials, Medical Necessity Denials, Eligibility Denials and More.

There are 3 Levels of Appeals:
Level 1 - Is almost always denied by the insurance company. You should expect this.
Level 2 - Requires more documentation and work on your part and your doctor's part.
Level 3 - If you do not agree with the outcome of the Level 2 Appeal, you can request a Level 3 Appeal, which is performed by an organization outside the insurance company. The Level 3 Appeal is the final ruling and the insurance company must abide by it.

[arwolfe]

Thank you! Appealing my 96 yr old grandfathers insurance. He’s been living entirely independently up until this recent health scare one month ago. He recovered enough to move from the hospital to a rehab center within 7 days the insurance was calling to cut off coverage for his care. It’s ridiculous. He can’t swallow normal food yet, or stand on his own, he’s a WW2 vet who dedicated the rest of his life to education and humanitarianism. Pathetic really how these companies and the whole healthcare system treat our elderly, this is first time my grandfather in 96 years has needed anything, some help, some time to recover after a life dedicated to serving others and the response has been to kick him to curb and let him die. Sorry for venting I’m just disgusted! Working on my 2nd level appeal now. Appreciate the info!

[juliamundt]

While IN hospital my husband was approved, then mid hospitalization denied continued coverage as unnecessary, then when the Peer to Peer Dr review was done it was covered toward the end of his 43 day stay again because he took a turn for the worse. This is insane. We will appeal.

[EstherEom]

Pharmacist here. I always appeal on behalf of my patients! I would say if I wrote a letter of medical necessity, 80-90% of the time, I am able to get the drug approved.

[jimmie-satx]

Got any tips for appealing an exclusion with an insurance company for a medically necessary procedure?

[BeanDar]

My question is how is somebody who is having early onset dementia supposed to handle all this? I'm 24 and this is happening to me and I have a hard time trying to figure all this out or where everything is at

[thomasjust]

The videos are good, but any video that tries to explain the US Healthcare system is near depressing, yet society itself is to blame, we are more concerned on other issues, while ignoring something that could save our life's

[springfling]

How do you get the documentation you need