It’s easy to
write an appeal…
The option to
appeal is a right you have when you disagree how services (claims/prescriptions/benefits) are processed with the carrier. When you
begin to write the appeal there are certain pieces of information you should
include to enable the appeal to be reviewed.
1.
Always have the word "appeal" somewhere in the letter.
2.
Make sure you include the policyholder's insurance information (member ID or social security number, date of birth). You will also need to include the patient name and date of birth. See example below:
Policy Holder- John Smith
ID# xxx-xx-xxxx
DOB xx/xx/xxxx
Patient Judy Smith
DOB- xx/xx/xxxx
Policy Holder- John Smith
ID# xxx-xx-xxxx
DOB xx/xx/xxxx
Patient Judy Smith
DOB- xx/xx/xxxx
3.
Make sure to include all dates of service you are appealing in the letter.
4.
Include
the reason you are appealing. (Tell your story/situation)
5.
Include any supporting documentation from your doctor or health professional.
An appeal can take up to 30 days. The explanation of benefits (EOB) gives the information where to
send the appeal to. Remember to keep copies of what you send for reference or
if you would want to appeal on a higher level with the carrier. Carriers
notify in writing directly to the member when the appeal is received and also when the
resolution on appeal has been rendered.
The Customer
Care Team is available to help with questions on the appeal process. Please
feel free to contact us Direct (937-) 260-4300 or toll-free
877-635-5372
