How to Appeal a Denied Claim?

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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
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• 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.
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