Starting the Appeals Process

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 the denial decision. You should request this documentation for your records. Your best documentation and evidential support for your appeal will come from your plan language. Most likely this information will be within the plan definitions for Covered Benefits, Non Covered Benefits and Exclusions.

When preparing for your appeal, seek additional support from your medical provider, including a statement of medical necessity, documentation of prior treatments, and the reason the treatment or service in question was ordered.