What help, information & resources can you suggest to help me file an
appeal or grievance with an Insurance Company?
The process of appeals & grievances gets very technical, legal, etc. I won’t even attempt to summarize it here. Please follow the links below, check your policy – evidence of coverage and check the law.
Did you use the Correct MD or hospital – Provider List and
Did you Review the procedures in your actual policy, evidence of coverage?
Here’s a sample Speciment EOC Evidence of Coverage – Platinum Plan Page 151
Reasons why the Claim might be denied
Billing Codes – Satire or how it really works?
Blue Shield – General Info. Appeals & Grievances PO Box 629007 El Dorado Hills , CA 95762 – 9007 Fax: (916) 350 – 7585
REQUEST FOR REVIEW OF CANCELLATION, RECISSION, OR NONRENEWAL OF HEALTH CARE SERVICE PLAN BENEFITS
Consumer Links & Resources
Free Advice.com WHAT IS THE APPEALS AND GRIEVANCE PROCESS LIKE?
Blue Cross Specimen Policy – Sample Appeals Procedures Page 151
How to gather documents to prove your case – Small Claims Manual
How to tell your story, timeline and background – actual attorney brief to the court.
How to create a TIMELINE in Word, Excel, PowerPoint
Appeal Guide – Washington State 62 pages pdf
Todd Friedman, Esq. can help if debt collectors are harassing you when you don’t owe the $$$
Other Pages in Appeals & Grievances Section
- Covered CA Appeals
- How we can help you with your grievance
- Independent Medical Review
- Last Minute Application? When does coverage start?
- Technical Links – Appeals & Grievances
Tools to Read a Statute
SNAFU - Situation Normal - All Fouled Up
Wikipedia - Including Videos
FAQ's - Ask us a Question
Denied Health Coverage? Appeal it
The U.S. healthcare system wastes close to three-quarters of a trillion dollars a year—and the implications are not just financial. Many of the tests, treatments, and procedures that comprise healthcare waste can expose patients to undue physical, emotional, or financial harm. http://www.milliman.com/waste