Appealing a Denied Claim from your Health Insurance
- Get a copy of your plan document and plan summary. Request them from your insurance company or go online if you do not have copies.
- Read the denial letter from the insurance company for information on how to appeal. Contact your health plan and request the information if it's not included.
Filing your appeal:
- File the appeal with your health plan quickly, as many companies place limits on how long appeals may be requested after a claim is denied.
- Many health plans require you to write a letter to appeal the denied claim. to help you with your own letter. Here are some sample letters you can use
- Ask your doctor for help by writing a letter of medical necessity and/or calling your health insurance provider. Your doctor and his/her staff are well qualified to explain your condition, medical history and treatment plan to your plan administrators. See our sample letters for doctors for assistance.
- Keep copies of correspondence from your doctor and from yourself to the insurance company.
- Record the names and job titles of the health insurance representatives you speak to and the time and date of your calls.
What to do when your health insurance still denies your claim:
- Talk to your employer's Human Resources department and let the benefits manager know if the health benefits offered at work do not allow you to access the medication or treatment you need. Your HR department may be able to influence the health plan to cover a particular treatment.
- The Psoriasis Foundation may be able to provide you with a letter supporting your claim. Please fill out our online form for assistance.
- If you've exhausted the appeal process with your health plan, you may be eligible for an "external" or "independent" review. The particulars of this process will vary state to state. Modify our sample letter to request an external review.
- Contact your State Insurance Commission to speak with a consumer advocate about your case.
Contact the manufacturer of your treatment
The manufacturer of the prescribed treatment, whether it is a biologic medication or a home phototherapy unit, may have insurance specialists that can help facilitate your appeal. Check out our financial assistance section for contact information.
The Patient Advocate Foundation offers assistance to patients with specific issues they are facing with their insurer, employer and/or creditor regarding insurance, job retention and/or debt crisis matters relative to their diagnosis of life threatening or debilitating diseases.
For more information on appealing a denied claim, read Kaiser Family Foundation's A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan and Families USA Resources for Health Insurance Appeals.