Insurance Appeals.... Learn From My Mistakes

Insurance… The very word makes me shutter a bit. Over the last several months I have become especially acquainted with my insurance as I have been trying to appeal their denial of a medication.

When I started out on the appeal process I thought it was going to be a piece of cake. I knew the terminology and the general principles behind it, so how hard could it be? Let me tell you, it's impossibly hard. So today I am going to help you learn from my mistakes so that you are better set up to win an appeal.

1. Don’t assume insurance received your appeal and wait 30days (or however long they said it would take for an answer). If you mail it, call after a week or so and ensure they received it.

2. Provide as much detail and proof as possible with your appeal. Don’t wait until your insurance asks for info to give it to them otherwise they will use your delay as an excuse to not finish the appeal on time. Here is what I suggest including with your appeal-

   1. A letter written from you detailing why you believe the med/treatment should be covered.

   2. A letter from your doctor explaining why it should be covered.

   3. Medical literature supporting the use of the med/treatment with your condition.

   4. Any relevant doctor’s notes from your file.

3. Keep every letter insurance sends about the appeal as reference.

4. Keep your reference number handy and regularly follow up with your insurance provider. My appeals got canceled several times and a couple of the times they didn’t even bother to notify me. Don’t assume they are just taking a while, follow up!

5. Research your options for getting a discounted price in case you are unsuccessful. Some medication manufacturers offer discounted or free meds directly from them if your insurance doesn't offer coverage of the med. Companies like GoodRx also provide coupons for prescription meds, so it's always worth looking into!

Insurance is an incredibly frustrating and complex system to deal with. Don't be afraid to ask for help and don't give up just because you get a "no".

Disclaimer-

All information provided on this blog is for educational purposes only. Always consult your healthcare provider and/or your insurance provider for your specific situation. This blog does not offer medical advice.