Insurance: appealing a denied claim

What if my health plan denies my claim?

Getting Started:

• Make sure you have a copy of your plan document and plan summary. Request them from your insurance company if you do not have copies.
  
• Information on how to appeal is usually included with the company's denial letter. If it's not, search the plan website, or call your health plan and request the information. 
• You can search for your health plan's contact information and medical policies for the treatment of psoriasis by visiting our Health Plan Directory.
  
• File an appeal with your health plan quickly, as many companies place limits on how long appeals may be requested after a claim is denied.
  
• Modify our template letters to appeal a denial or request information from your health plan. 
  
• Ask your health care provider to take action to support your case and write a letter of medical necessity to your health insurance plan.  
• Talk to your employer's Human Resources department: you can let the benefits manager know if the health benefits offered at work do not allow you to access the medication or treatment you need and they may be able to help.
• See our tips and resources for appealing.

I tried appealing, but my health plan is still denying my claim. What do I do now?

External Review:

• If you've exhausted the appeal process with with your health plan, you may be eligible for an "external" or "independent" review. Specific information and instructions for applying to your state's review program can be found through the Kaiser Family Foundation. Modify our template letter to request an external review.