Question
Can I file an internal appeal if my health plan won’t authorize services or refuses to pay the portion of health care expenses I believe should be covered?
Yes Answer
Correct!
Denial reasons can include:
- The benefit isn’t offered under your health plan;
- You received health services from a health provider or facility that isn’t in your plan’s approved network;
- The requested service or treatment is “not medically necessary”;
- The requested service or treatment is an “experimental” or “investigative” treatment;
- You’re no longer enrolled or eligible to be enrolled in the health plan; or
- It is revoking or canceling your coverage going back to the date you enrolled because the insurance company claims that you gave false or incomplete information when you applied for coverage.
No Answer
Incorrect!
Denial reasons can include:
- The benefit isn’t offered under your health plan;
- You received health services from a health provider or facility that isn’t in your plan’s approved network;
- The requested service or treatment is “not medically necessary”;
- The requested service or treatment is an “experimental” or “investigative” treatment;
- You’re no longer enrolled or eligible to be enrolled in the health plan; or
- It is revoking or canceling your coverage going back to the date you enrolled because the insurance company claims that you gave false or incomplete information when you applied for coverage.
