Health Insurance Consumer Guide

Appealing an insurance company decision

If your health insurance company doesn’t pay for a specific health care provider or service, you have the right to appeal the decision and have it reviewed by an independent third party.

Your insurance company must first notify you in writing within a set amount of time (based on the type of claim you filed) to explain why they denied coverage. They also must let you know how you can appeal their decisions.

If the timeline for the standard appeals process would seriously put your life at risk, or risk your ability to fully function, you also can file an appeal that would get you a quicker (or “expedited”) decision. If you meet the standards for an expedited external review, the final decision about your appeal must come as quickly as your medical condition requires, and no later than 72 hours after your request for external review is received.

If you have questions contact Health Help Mississippi at 601-354-3470 or 1-877-314-3843