APPEALING INSURANCE DENIALS
If your health insurance denies coverage for your treatment, you have the right to submit an appeal.
For higher levels of care (RTC, PHP, IOP), there are two types of insurance appeals:
Internal appeal: your insurance company does a “full and fair review” of its decision to deny coverage for treatment. You can learn more about internal appeals here.
External review: an independent third party determines whether your insurance company should have denied coverage for treatment. You can learn more about external reviews here.
For outpatient levels of care (Therapy, Nutrition):
Your providers may submit a letter to your insurance company to advocate on your behalf. You, as the member, can also send a letter in addition to the provider’s letter to further advocate for yourself.
CLICK BELOW TO VIEW SAMPLE APPEAL LETTERS:
Sample Letters to Use With Insurance
Submitting Appeals to Insurance for OSFED Treatment Denial
