Insurance Appeals

Insurance claims do not always proceed smoothly. When coverage is denied, your doctor may need to request a peer-to-peer review, or you may need to file a formal appeal. Know exactly what your appeals process is before you make the phone call or write the email or letter as most appeal processes have specific time limits for each step once an appeal has started. Don’t be caught off guard. This appeals information and what your insurer is contractually required to cover is contained in your full policy.

• Learn to write a great appeal letter. Examples of appeal letters and more information about navigating coverage denials are available online.
• Search NET organizations online for educational articles and videos regarding denials and appeals. The information can help you better understand the appeals process and how to get the coverage that you have paid for and that you have a right to receive.
• Contact your state’s Insurance Commission for difficult issues and concerns relating to your coverage. The insurance commissioner is a state-level position in all 50 states and duties vary state to state, but their general role is as a consumer protection advocate and insurance regulator. Non-profit organizations like the Cancer Legal Resource Center are also a valuable resource for insurance related issues and other legal rights of people with cancer. See Legal and Financial Resources.