Where to start
Appeals generally have three phases:
- Denial of request for service or payment
- Internal appeal to your health plan
- External appeal to an independent reviewer (for certain denials)
To know what appeals process you will follow, you need to answer these questions:
- What kind of insurance do you have?
- Do State of Oregon or federal officials regulate your plan?
- Is your plan a new plan (non-grandfathered) or an old plan (grandfathered)?
- Is your denial a "pre-service" issue, meaning you have not yet received the services, or a "post-service" issue, meaning you have received the services and may be receiving a bill?
- If it's a pre-service issue, is it urgent? Urgent means that your health may suffer if you do not receive the service.
