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 the Marketplace Call Center at 1-800-318-2596. (TTY: 1-855-889-4325.)
Learn more about the appeals process.
Source: HealthCare.gov, “Appealing an insurance company decision.” http://www.healthcare.gov website. Accessed December 2, 2015. https://www.healthcare.gov/using-your-new-marketplace-coverage/#part=6
© Copyright 2016. All rights reserved. This content is strictly for informational purposes and although experts have prepared it, the reader should not substitute this information for professional insurance advice. If you have any questions, please consult your insurance professional before acting on any information presented. Read more.