Category Archives: Insurance Denials & Appeals

Filing a Formulary Exception

This article informs you if you need a medication that is not on your plan list, that you can formally ask your insurer to cover the medication for you by submitting a “formulary exception” and how to.

Gather the Details & Get Organized

This article states that while you may be upset or discouraged because of an insurance denial, you have an opportunity to organize yourself and make the best argument possible to sway your insurer into covering the denied service, testing, or medication.

Insurance Challenges with Medication

This article discusses common insurance challenges that may happen when you're trying to access your medications.

If it is Not a Bill, Why is the EOB Important to Me?

This article discusses the importance of keeping your Explanation of Benefits, known as EOB, in an organized system, usually by date of service, to reference as you progress through the insurance and payment portions following your care and medical treatment.

What Your EOB Contains & Why You Should Keep Them

This article explains what's on your EOB and the reason it's important to keep them for potential future disputes you may have with your insurance company.

My Insurance is Not Paying for My Medications

This article discusses that if your insurance is not paying for your needed medications, you must first find out the exact reason it is being denied.

Where to Start if Insurance Has Denied Your Service and Will Not Pay

In this article you will learn that if your insurance plan refuses to approve or pay for a medical claim, including tests, procedures or specific care ordered by your doctor, you have guaranteed rights to appeal. These rights were expanded as a result of the Affordable Care Act.

Insurance is Unable to Process Your Claim

This article discusses, when you review an explanation of benefits from your insurance company, you may see instances where a claim hasn't been processed or you notice the insurance company has not paid or adjusted the claim at all. Sometimes your medical claim is unable to be processed at the time of the submission, which is different than a "full" denial.

Starting the Appeal Process

This article informs that it can be hard to know how to organize yourself as you move into the appeals process, but as a plan member you have the right to the full length version of the plan’s medical policy or a copy of the information used to make their denial decision.

Things to Include in Your Appeal Letter

This article informs you that appealing to your insurance company can certainly seem intimidating. But it doesn't have to be if you stay organized! One of the most important elements of your appeal packet is a clear, concise letter detailing your counter-argument that addresses the original reason for denial and citing the terms of your policy.