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?
Anthem Blue Cross Fined $415K since the California Department of Managed Health Care said it found 40 cases in which Anthem deprived members of their grievance and appeal rights. – CA Healthline 5.3.2016
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 $$$
Sample Appeal Letter-
62 page guide - DOI Washington State
Denied Health Coverage? Appeal it
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?
- Mistake? Deadline to Report?
- Technical Links – Appeals & Grievances