internal review: your first step is to request an internal review of the decision you want overturned by your health plan. your insurer should send you instructions explaining how to do this and the deadlines you'll have to meet. it must also send you a notice once it has reached a final decision and include an explanation of the outcome. here are some documents you'll want to start collecting in order to initiate the appeal: your insurance plan or group number and/or social security number your doctor's name and the bill for the services in question description of the service you want covered and why explanation of benefits (eob) forms copy of the health plan booklet section that describes coverage related to treatment copies of the medical records that relate to the service or treatment in question external review: if you're not satisfied with your insurance company's ruling you have the right to an external review which is conducted by an independent third party (often your state insurance department). your health plan should include information about how to file an external appeal in the notice it sends you. if you haven't gotten the information and get your insurance at work talk with your human resources department to ask for help. you can also contact the u. s. department of labor's employee benefits advisors (866-444-3272). your state's insurance commissioner's office is a great place to go for help too; many are setting up consumer assistance programs that work with consumers on health insurance appeals. for more detailed information about appeals processes under the law see " your right to appeal " on the nonprofit families usa website.
how do i appeal a denied health insurance claim?