Step 1 of 3 in the journey
A denial is a first answer.
Find out exactly what it says.
Before you write anything, get four facts straight: what was refused, the reason given, what kind of coverage you have, and your deadline. Everything else follows from those.
What do you need to do?
- Read your denial letter Find the reason, the rule the plan relied on, your appeal rights and your deadline in the letter.
- Read your Explanation of Benefits Tell what the plan paid, what it refused, and what you may owe, before you pay anything.
- Work out whether it is really a denial Separate a denial from a rejected claim, a request for more information, and your normal share of the cost.
- Find the real reason Turn the wording on the letter into a reason you can answer, and see who has to act first.
- Find out what kind of coverage you have Work out which kind of plan you have and who regulates it, because every later answer depends on it.
- Know your deadlines Turn the date on your notice into the dates you and the plan each have to meet.
Your next step may connect
- Build your case
Collect the file, the records, your doctor's support and the plan's own rules, then write it up.
- Your coverage
The appeal steps, deadlines and regulators for your kind of plan, from employer plans to Medicare and Medicaid.