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Appeal a Health Insurance Denial

If your health insurance recently denied you coverage for a medical service or treatment, you have the right to dispute this decision through your plan’s internal appeal process. If you qualify, OPP can also send your case out to an independent external r

Did your health plan recently deny payment for a medical service or treatment? Your insurance company may have sent you a denial letter or notice telling you this.

Step 1- File an Internal Appeal: You can ask your insurance company to reconsider this decision through an internal grievance or appeal, a process handled by your health plan. Your insurance company must give you a new decision within 30-days, or sooner if medically necessary.

Step 2- Request an External Review: Did your insurance company deny your internal grievance/appeal in the last 4 months? If your plan is “fully-insured,” and your case qualifies, OPP can request an independent third party to make a new decision about your case. This is called an external review.

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