If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party.
You can ask that your insurance company reconsider its decision. Insurers have to tell you why they’ve denied your claim or ended your coverage. And they have to let you know how you can dispute their decisions.
YOUR RIGH TO APPEAL
There are two ways to appeal a health plan decision:
Internal appeal: If your claim is denied or your health insurance coverage canceled, you have the right to an internal appeal. You may ask your insurance company to conduct a full and fair review of its decision. If the case is urgent, your insurance company must speed up this process.
External review: You have the right to take your appeal to an independent third party for review. This is called external review. External review means that the insurance company no longer gets the final say over whether to pay a claim.
If your Explanation of Benefits (EOB) shows that your health insurer is refusing to pay for services you think should be covered, call the insurer to see on as to possible errors. If it’s truly a denial of coverage, you may need to file an appeal. Three are specific steps for dealing with this. Contact: healthcare/appealinsurancecompanydedision/appeals.