The purpose of this guide is to help you understand your appeal rights when you get a denial from your health insurance company.
This guide reflects 2011 changes to the appeals process required by federal health care reform. Not all plans had to make these changes. Talk to your health insurance company to find out how to appeal if your plan is grandfathered (existed before March 23, 2010, and meets other criteria).
More than 40 percent of consumers who challenge a claim denial win on appeal, generally as a result of an internal appeal to the company.
Ask your insurance company if you need any forms to file your appeal. Send your completed appeal letter or forms (if required) directly to the company.
For help understanding appeals, call our Insurance Division consumer hotline at 1-888-877-4894 (toll-free). Ask to speak with a Life and Health advocate.