Things to consider before you start your appeal
To file an actual appeal, you or your authorized representative will need to follow the process established by your health plan. However, before you file an appeal, here are some things to consider:
- Find out about the appeals process - What to expect if you decide to file an appeal.
- Find out what you can do about your bills during the appeals process.
- Identify your type of insurance coverage - Find out if you have a group, individual or government-sponsored plan, and which law your plan follows.
- Information about state or federal plans - Appealing denials from Medicare, TRICARE, Apple Health for Kids and similar plans.
- Find out what the appeals process looks like if you have a non-grandfathered plan or a grandfathered plan.
- See a list of common reasons for a denial and example of appeal letters that you can use.
- See a searchable directory of independent review organization (IRO) decisions for health insurance appeals - If your health plan upholds a claim denial after you complete its appeal process, you can request an external review of your appeal by an IRO. An IRO isn't affiliated with your insurance company and doesn't have a financial interest in the outcome of your case.
Our IRO search tool allows you to search IRO decisions, where you can modify your search based on a number of factors, including cases involving your insurance company, diagnosis, treatment, outcome or reason for the appeal.
Note: Whether or not you file an appeal, you may also want to file a complaint with our office. The appeals and complaint processes are different, and can take place simultaneously without affecting each other. If in doubt, you may want to try both avenues to resolve your issue.