How to File an Appeal when Healthcare Coverage is Denied

You no doubt heard of the new Obama Care Health Laws taking full effect by 2014. If you are not aware of these changes, then you will be aware very soon. You are probably like many other people and are not quite sure how these changes will fully affect you.

Many people feel that there will be more denials for health care claims than ever after the new healthcare laws take effect. This one bit of information is mainly affecting you and your private health insurance coverage.

If you turn in a healthcare insurance claim and are denied payment of this claim, word has it that it is urgent you file an appeal. Doing so makes it more than likely you will see payments made the second time around.

Many people experience a rejected claim; however, the Affordable Care Act is designed to protect people against these denials. Because the Affordable Care Act is not fully implemented at this time, healthcare claims will continue to be rejected.

When you want to file a healthcare insurance appeal on a claim denial, the appeal is filled through the United States Labor Department. It is sometimes a good idea if you contact the nonprofit Patient Advocate Foundation. This website is devoted to pre-existing conditions. This site gives you pre-existing condition insurance plans and is part of the new Obama Healthcare Act.

When you take action to counteract a denied healthcare insurance claim, then you must file an appeal on the denied claim. If you disagree with the Medicare, Medicare health plan or Medicare Prescription Drug Plan decision, then it is your right to appeal a denied claim.

The first step is to contact your plan’s company and get all the details about your appeal rights.

You can expect five different levels for the appeal process. You may disagree with the decision made at any of these five levels. If you disagree, you then move to the next level. You will receive a letter with specific instructions on how you move to the next level of appeal.

These five levels include Medicare appeals, Medicare health plan appeals, Medicare prescription drug coverage appeals, Special needs Plan appeals and get help filing an appeal through State Health Insurance Assistance Program (SHIP). If you require a representative, it can be a member of your family, an attorney, your doctor, a friend or an advocate who will act on your behalf.

Fill out an Appointment of Representative form, submitting in writing this request with your appeal. Always include:

• Your name, address and phone number

• Your Medicare number

• Appoint your representative in writing with the representative’s name, address, and phone number

• Relationship of representative to you

• A statement as to why you need a representative

• You must sign and date the request

• Your representative must sign and date the request

You will see in one of the levels of this process where your doctor or prescriber can make this request on your behalf. They do not have to be appointed a representative on your behalf.

Make sure that you add your Medicare number on all documents with your appeal request and make copies of all documents before you send them to Medicare.

Frequently, the appeals process takes some time. If you are in a hurry because you are a hospital inpatient, have in-home health services, are a resident in a skilled nursing facility or rehabilitation facility or on hospice and feel that Medicare has ended your services too soon, then you have the right for a fast appeal.

Appealing a Medicare Advantage Plan or any other Medicare health plan

You, your representative or doctor, can request an organization determination if you think your plan must provide or pay for items and services. This is your right.

• You must receive in writing why your company will not pay or give you the needed items or services requested

It is your right to ask for a fast decision. Normally you would have to wait two weeks for a decision. If this waiting period is going to be harmful to your health, a decision must be forthcoming in 72 hours. It is wise to request all copies of documentation from the insurance company.