Clip and Copy: Helping patients appeal insurance denials

This handout points them—and you—in the right direction.

Sometimes, health plans make coverage decisions that may strike you and your patients as arbitrary, capricious—or just plain wrong.

Fortunately, there are safeguards in place to protect your patients' interests. All 50 states give them the right to appeal coverage decisions to an in-house panel. Forty-three states and the District of Columbia offer an additional level of protection—the right to appeal to an external or independent review board.

But appeals, whether internal or external, can gobble up your time. The key is to help your patients help themselves.

To assist you in doing that, we've put together the patient handout you can download below. It contains valuable tips for the patient contemplating an appeal—including how to work effectively with you and what steps they need to take on their own. It also contains a list of resources that your patients can turn to for additional help and guidance.

This is your chance to speak directly to your patient about a matter of common concern. We encourage you to photocopy the form (we've left room at the bottom for you to stamp your name). You can also have the form commercially copied and customized.

To learn more about helping patients appeal an insurance turndown, turn to the feature article "When an insurer won't pay".

This is the first in an ongoing series of "Clip and Copy" forms designed for you to use in your practice. Subsequent installments will touch on matters relating to Medicare, fees, copayments, tiered pharmaceutical benefits, and the like. In addition, look for a series of forms to help you run your practice more efficiently.

—Senior Editor
Wayne J. Guglielmo

Other forms and patient handouts are available in the Clip and Copy section of our Web site at www.memag.com .

Wayne Guglielmo. Clip and Copy: Helping patients appeal insurance denials.

Medical Economics

May 9, 2003;80:118.