If your health plan has refused to pay for care, or denied a mental health claim, you have the right to appeal and ask your health plan to reconsider their decision. Once you decide to appeal, here are some important steps to take:
- Contact your health plan. Make sure you have the reason for the denial in writing. Use this letter template to request or have your provider request written notification of the denial.
- Contact your mental health provider. They may be able to help you with the appeal.
- Keep copies of everything. If you speak to a representative on the phone, document the call in writing. If possible, send a follow-up e-mail.
- Get copies of all the forms you need to submit, and make sure you fill out all the forms required by your health plan. Be sure to include your name, your claim number and health insurance ID number.
- You may use this letter template as a model to appeal your claim.
- Make sure you meet all deadlines in the review and appeals process. Generally, appeals must be filed within 180 days of the denial of services.
- If the situation is an emergency, request an expedited appeal.