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Insurance Appeals Do’s and Don’ts

It is your right to file an appeal for payment with your insurance company if you feel that a drug or service should have been covered but wasn’t. Follow this list of “Do’s and Don’ts” to increase your likelihood of success in your appeal.

DO:

  • Use the phone numbers on the back of your insurance card to call and find out how to make your appeal.
  • Make your appeal as soon as you decide to appeal. Appeals have a time limit, no matter the insurance type, and they take time. The sooner you get started the better.
  • Ask your doctor for help with an appeal.
  • Follow the steps your insurance plan tells you to do.
  • Think about asking someone you know to help you with the appeal.
  • Make copies of your paperwork before you send it to anyone.
  • Include your name, address and phone number in your appeal.
  • Include your doctor’s name, address and phone number in your appeal.
  • Include your insurance ID number and any other claim number on everything you send with your appeal.
  • Include the name of the drug or service you are appealing.
  • Include any copies you can get of your treatment records from your doctor.
  • Include a copy of any representative authorizations.
  • Include any other items you think support your case.
  • Be as detailed as possible about what you are appealing.
  • Call your doctor and pharmacy after a few days to make sure they are working on your appeal.

DON’T:

  • Don’t wait too long to appeal. Appeals all have a time limit, no matter the insurance type.
  • Don’t think you have to do this by yourself. Most doctors’ offices will help or you can look into getting someone to help.
  • Don’t send paperwork if it doesn’t have anything to do with your appeal.
  • Don’t send paperwork you already sent unless the insurance company asks for it again.
  • Don’t send your original paperwork. Only send copies (unless you are told to send the originals).
  • Don’t hesitate to call your insurance with any questions. The phone number is on the back of your insurance card.

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