News and Notes from The Johnson Center

Navigating Insurance: The Appeals Process

JCCHD | Tue, June 30, 2015 | [Autism Treatment]

In our recent webinar Understanding and Optimizing Your Health Insurance Coverage: What Every Parent Needs To Know, we discussed information regarding what to do in the event that your claim to your insurance company is denied. This is called the Standard Appeals Process. 

It is not unusual that you will file a claim for a service that is initially denied by your insurance.  There is a fairly simple process to appeal this decision.


Most insurance carriers have specific forms that are required to process an appeal. These are typically found on your insurance carriers website (there is usually a section titled “Forms”). If you don’t have access to the website, call their Customer Service line and ask a representative to send you the forms.

Try to submit as much information as possible to support your request for an appeal. Documentation from your clinician is often helpful. Be sure to read the reasons for the denial on the Explanation of Benefits that your carrier will have provided to you so that you are sure to answer any outstanding questions or misinformation they may have.

Almost all insurance policies outline the time frame for submitting an appeal and for receiving responses from the carrier.

Watch the webinar to learn more about the levels of appeals, how to expedite an appeal in an urgent situation, tips on how to write an effective appeal letter, why you should include published research related to your appeal, and when there is no value in appealing.

Insurance companies do reverse their decisions on appeals, so it is important to understand the process if you have been denied.