Insurance Appeals

When do I submit an insurance appeal?

If your medical bills are a result of a denied insurance claim, your best path to reducing your medical bills could be to submit an insurance appeal. The insurance appeal process is well established at all major insurers.

There may be a deadline for when your insurance appeal must be filed. Be sure to check on any important deadlines and leave yourself plenty of time to prepare your appeal.

What documents and evidence do I need to submit an insurance appeal?

To prepare for your insurance appeal, you should gather your Explanation of Benefits (EOB) and Itemized Hospital Bill. Your EOB will explain the reason for your denied claim. The itemized hospital bill will include the billing codes for all services you received. Review them together to understand in detail what caused the denied claim and why.

A successful appeal of a denied insurance claim may include the following documents and information in your submission:

  • Referral from your primary care physician
  • Relevant history from your Electronic Medical Record
  • Letter of Medical Necessity
  • The insurer’s required appeal letter form

How do I submit an insurance appeal?

You will need to pay attention to detail and follow your insurance company’s directions as closely as possible. This process will take hours of effort and may require weeks to gather any documentation you are missing. Organization is critical.

  1. Understand the Process and Paperwork: Visit your insurance company’s website to understand the requirements and make a checklist and timeline for yourself.
  2. Gather All Evidence: Gather referrals, medical records, letters of medical necessity, insurer appeal forms, and write your own explanation of your procedure and why it should be covered.
  3. Submit Your Insurance Appeal and Follow Up: Double check that you have followed all directions precisely and submitted all required documents. Call every 2-3 weeks to check on the status of your claim.

What resources can help me submit an insurance appeal?

  • Your primary care provider may be able to provide advice and resources to guide you
  • Medical Billing Advocates like Resolve can help sort through the technical details and advocate for you with the large insurance companies.

Insurance appeal process tips

  • Know the requirements and deadlines: You may have limited time to submit an insurance appeal.
  • Get organized: You may need to collect information from many different documents over an extended period of time. 
  • Get evidence: Make sure you submit a strong and compelling appeal that directly proves your claim.
  • Follow up: Persistence is key. The insurance company has no incentive to expedite your appeal. You have to push for progress.
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