If you need a medical procedure done, and it is denied, you feel helpless. What do you do? To whom do you turn? What now? However, what many do not realize is that the Oklahoma City, Oklahoma, denial is not an absolute no. You can appeal through both the internal and external appeal process.
The internal appeal process
Essentially, this is the insurance company’s own appeal process. It must be a full and fair review of its decision. And, if it is an urgent matter, the insurance company must expedite the appeal process.
The external appeal process
In sum, if you are not satisfied with the internal appeals process with the insurance process, you have the right to have an independent, third-party review your complaint. This is called an external review, and the insurance company loses their ability to approve or deny your Oklahoma City, Oklahoma, claim.
Step 1 of the internal appeal
There are three steps to the internal process. The first part is your appeals filing, where you were denied and you appeal the denial. The insurer must notify you in writing of their authorization decision within 15 days (or 30 days if the medical service was already done). If the medical care is urgent, it must be done within 72 hours.
Next, you file the appeal by filing the required health insurer appeal forms. You can also write your insurer, stating that you want to appeal. Do not forget to include your name, claim number and insurance information. Submit all of the additional information that your insurer needs, including additional medication documentation.
Help
If you need help, you can contact an Oklahoma City, Oklahoma, health insurance attorney who can fight on your behalf. However, states also have consumer assistance programs that can file appeals on your behalf as well. Remember, your appeals must be filed, usually within 180 days of your denial.
Urgency
If your appeal is urgent, you can ask for a concurrent internal and external review. Even if you do not ask for a concurrent review, make sure that your appeal makes it clear that your appeal is urgent. And, in a future post, we will discuss the additional appeal information, including the Oklahoma City, Oklahoma, external review process.