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.