How to Appeal Medical Devices Denied by Health Plans
- 1). Obtain a written copy of your claim denial from your insurance provider, if you don't have one already. Review the form to determine the reason for the denial. If you were denied because your health plan does not cover the medical device, review your current insurance policy to ensure that the device really is not covered. If it is covered, you should be able to appeal.
- 2). Request a letter or note from the physician who prescribed the medical device, if it was prescribed. Ask your physician to explain why you need the device, what it is used for and how you will benefit from having it, and to state that there is no other equally proficient alternative for your condition.
- 3). Draft a written appeal. State your full name, the name of the insured (if you are insured under your spouse's plan, for example), and the policy number.
- 4). Detail the reason for your appeal. Explain why you believe your claim should be approved. Quote specific sources from your insurance policy that prove the medical device is covered by the plan. Copy any pages from your policy that you quote, and attach these to the back of your appeal letter.
- 5). Give the insurance provider a time limit to review your appeal. Ten business days is sufficient time for your provider to review it and provide you with a written response.
- 6). Provide your mailing address and other contact information at the bottom. Request that the insurance company contact you by mail or by e-mail only, so that you have an indisputable paper trail that will demonstrate any promises made by any insurance agent to whom you speak.
- 7). Sign the letter and make a copy of the letter, the physician's note, insurance policy, and any other documents you submit. Retain the copies for your personal records.
- 8). Send the letter and attachments via Certified Mail with signature delivery. Retain the delivery receipt for your records to prove that you sent the letter and that it was received.
- 9). Repeat this process for every additional denial you receive from your insurance provider. Keep trying until your provider accepts and covers your claim. If you are unsuccessful after multiple attempts, consult an attorney to assist you with appealing the denial again.
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