Urgent or Expedited Appeals

Filing an appeal to your insurance company can be a lengthy process, but it certainly doesn’t have to be. You or your representative can request an expedited appeal verbally by calling the insurer directly.

Urgent appeals are only considered in situations where:

  • You are currently receiving the treatment and your medical provider believes a delay in treatment could seriously jeopardize your life or overall health, affect your ability to regain maximum functions, or subject you to severe and intolerable pain.
  • Your issue is related to an admission or continued inpatient stay and you have not yet been discharged

You cannot begin an expedited appeal if:

  • You already received the treatment and disagree with a claim denial, or
  • Your situation is not considered to be urgent by a medical provider with knowledge of your medical condition or the medical director of your insurance plan.

Your insurer must respond to an expedited request within 24 to 72 hours. The plan may deliver the decision verbally, but a verbal decision must be followed with written documentation within the following 72 hours.

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