Appealing insurance decisions goes hand-in-hand with having a child with special needs. With the right preparation, your appeals will be more successful.

There are five important steps to any appeals process:

1.      Contact your insurance company, and ask them to put their reasons for denying your claim in writing.

2.      Hire a lawyer to help you negotiate and navigate potential roadblocks you will face during the appeals process.

3.      File the appeal, using the system and time frame dictated by the insurance company.

4.      Gather information that will help in your appeal, such as test results, medical records, and medical reports. Your lawyer will be able to inform you about what kinds of information the committee is looking for.

5.      Ask treating doctors to clear their schedules for the hearing date. If they can’t testify in person, make arrangements for them to testify by phone.

Your HIPAA rights are very important during the appeals phase. Make sure you don’t allow your insurance company direct access to any medical records or staff. For more information, click on our HIPAA page.

External Appeals

If your appeal is denied you have the right to another appeal. If you’ve gone through the entire internal appeals process, you may be able to request an external appeal. Whether or not you have access to external appeals depends upon the state you live in. Because the process varies from state to state, it’s best to have a qualified attorney help you handle the complexities of your state’s process. Feel free to contact us for more information on how we can help.