How to Appeal an Insurance Denial

What this article is about: This article provides a brief overview of how to appeal an insurance denial and links to a resource where you can find more information and support.

If you have a child with special needs, chances are you will deal with insurance denials from time to time.  This article from Complex Child magazine is an excellent place to start and even includes a sample letter for your appeal.

Resources

National Conference of State Legislatures:  Autism and Insurance Coverage:  State Laws

Resources

Community Catalyst Consumer Complaints Toolkit: http://www.communitycatalyst.org/resources/tools/consumer-complaints-toolkit

National Disability Navigator Resource Collaborative Mental Health Parity Factsheet: http://www.nationaldisabilitynavigator.org/wp-content/uploads/Materials/Fact-Sheet-7-Mental-Health-and-Substance-Abuse-Parity.pdf

National Disability Navigator Resource Collaborative Civil Rights and Disability Discrimination Factsheet: http://www.nationaldisabilitynavigator.org/wp-content/uploads/Materials/Fact-Sheet-11-ADA_504.pdf

Healthcare.gov: Consumer Rights and Protections: https://www.healthcare.gov/health-care-law-protections/rights-and-protections/

Centers for Medicare and Medicaid The Mental Health Parity and Addiction Equity Act: https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html

SAMHSA (Substance Abuse and Mental Health Services Administration) Health Financing: http://www.samhsa.gov/health-financing

Help for consumers – appeals

State Departments of Insurance

State Attorney General offices

ERISA (Employee Retirement Income Security Act – private plans)

CMS (Centers for Medicaid/Medicare Services) – public plans

OCR (federal Department of Health and Human Services Office on Civil Rights) – discrimination