Undivided Resources
Parent Question

Can I appeal an insurance claim denial?


Published: Feb. 2, 2022Updated: Mar. 17, 2022

Before you start an appeal, be sure that there is a solid basis for your request. If so, you’ll want to tell a concise and compelling story, substantiated by facts, regarding the terms of the benefits and coverage on your plan. Remember that you are appealing for what the plan is obligated to deliver that qualifies as medically necessary and is not specifically excluded from your health plan.

Review the plan’s evidence of coverage (EOC) for any parameters established to exclude, limit, or narrowly define the service you want funded. This lengthy document can often be found in your plan’s member portal or via call or live chat with customer service. For some employer-based plans, it is available only from the HR department. The EOC will typically list excluded diagnosis or treatment types.

For more information about dealing with insurance claim denials, see our article Insurance Claim Denials and Appeals 101.

Blue asterisk
Liney circle
Join for free

Save your favorite resources and access a custom Roadmap.

Get Started
Tags:

Promise Image
Each piece of content has been rigorously researched, edited, and vetted to bring you the latest and most up-to-date information. Learn more about our content and research process here.
A Navigator is your Partner at each turn
Every Undivided Navigator has years of experience supporting families raising kids with disabilities or parenting their own. Partner with an Undivided Navigator for a free Kickstart to learn first hand what support feels like!
tick-icon
Expert-driven content, guidance, and solutions.
tick-icon
Member events and office hours with real answers, plus access to our private parents' group.
tick-icon
Priority to begin a free Kickstart of the Undivided Support System with a dedicated Navigator.
“It’s so helpful to have one place that you can go to get many answers.”–Leeza Woodbury, with Navigator Kelly since 2020
*Currently offering Navigator Kickstarts to residents of California