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.
- 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 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.