How to Appeal a Denied Claim

1. How to Appeal a Denied Claim? Your health plan will check if a treatment, service, or prescription is covered either before or after you file a claim. If your health plan won't pay for medically necessary services, treatments, or medicines, you can appeal the decision through your plan's internal appeal process. Step 1: Review Your Plan Check the documents for your health plan or call your health plan or employer to find out how to file an appeal for your plan. Usually, if you want to change a health plan's decision, you have to fill out forms or write a letter. Step 2: Submit Your Appeal Usually, you have 180 days (six months) from the time you found out your claim was denied to file your appeal. You can send the health plan any other information you want them to think about. Your appeal doesn't have to be technical, but you should say what claim denial you are appealing and why you think the company should look into it again. Step 3: Keep Copies

2. Make sure you keep copies of all information, including information from the plan, about your claim and why it was denied. Among these are: • Your Explanation of Benefits (EOB) forms tell you what your insurance covers. • Send the company copies of everything you send them. • Notes from any talk you have with your health plan about the appeal Step 4: Requesting an Independent Review When you have gone through your health plan's internal appeals process as many times as you can, you may have the right to have an outside, independent review organization look at the decision (IRO). If your health plan won't pay your claim because it thinks the treatment is unnecessary, wrong, experimental, or being looked into, it must give you a form for an independent review. The review must be paid for by your health plan, and the IRO's decision must be followed. After you send in your appeal, the IRO must make a decision within 5 days for emergency treatment and within 20 days for non-emergency treatment. Health plans don't have to give an IRO for services they don't pay for. Some health plans, like Medicare, Medicaid, and ERISA plans, are not required to take part in the IRO process. For more info on Visit our Website: https://ajustsolutions.com/ or Call us given number 1 - 855-657-3311.