Understand the reason your claim was denied. The reason for denial is located at the bottom of your explanation of benefits (EOB) mailed to you by your insurance company.
Read your benefit guide to familiarize yourself with your medical insurance plan benefits. If you do not have a benefit guide, you can call your insurance carriers customer service number to receive one.
Decide whether you are wanting to appeal a decision or make a complaint.
An appeal is a timely review and/or reconsideration of a item or service which includes an argument as to why you believe your claim was processed incorrectly regarding a denial of payment for a service that has already been provided.
A complaint is an expression of dissatisfaction with your insurance carrier's product or service. An appeal may include a complaint, but a complaint without a clear expression of your desire for your medical insurance company to reconsider their determination is not an appeal.
Determine where your letter needs to be mailed to and to whom. This information can be found on your EOB or in your benefit guide. Start your letter by stating the reason for writing the letter. If you are writing to appeal, clearly express your desire for a reconsideration of your medical insurance determination and ask your doctor for any information related to the claim that might help your case.
Follow up within two weeks to a month if you have not received a decision from your insurance carrier. Confirm the letter was received and ask how long the appeal process can take.