Nonprofit ยท Triage Cancer
Triage Cancer state-by-state health insurance appeals toolkit
Free downloadable toolkit with general appeals guidance plus a section and forms for each state. Made by a cancer-focused legal-education nonprofit, but the page describes it as for people using health insurance and challenging denials.
Know before you go
Free to download. Part I explains health insurance and appeals in general; later parts give state guidance, how to file external appeals, and forms based on where you live and the type of insurance you have. The organization's focus is cancer, but the page presents the toolkit for individuals and providers generally. Our research review found Medicare and Medicaid covered more lightly, and some Triage Cancer resources show drug company sponsor logos. State rules differ, so use your own state's section.
- Cost
- Free (the page calls it a free toolkit)
- Where
- Nationwide
- How to start
- Open the page, choose your state from the list, and download that state's toolkit and forms.
- Have ready
- Your state of residence; Your plan type, if you know it (employer plan or individual plan); The denial letter
Where this comes from
- Provider
- Triage Cancer
- Source we read
- https://triagecancer.org/AppealsToolkit
- Date we read it
- . This is not a fresh check.
- Date the provider printed
- Not displayed
- What we checked
- We read the provider's public page. We have not verified availability, eligibility or outcomes for any individual.
Other starting points
- Program or service
Beneficiary and Family Centered Care Quality Improvement Organizations: find yours
The Medicare contractors that handle fast appeals when hospital or other care is ending too soon, and complaints about the quality of care. Each state is assigned to one of two organizations.
From Centers for Medicare & Medicaid Services
- Program or service
California Department of Managed Health Care: Independent Medical Review
California's regulator for managed care plans reviews denials of medical services, emergency payment and experimental treatment through Independent Medical Review. One form starts either a review or a consumer complaint.
From California Department of Managed Health Care
- Program or service
Center for Medicare Advocacy self-help materials
Downloadable self-help toolkits for Medicare denials involving home health care, outpatient therapy and skilled nursing facility care, from a nonprofit law organization. The page describes materials, not a helpline.
From Center for Medicare Advocacy