Appealing a denied insurance claim
Psoriasis patients have the right to appeal a denied claim from their insurance company. The National Psoriasis Foundation provides information to patients and physicians to help them navigate the appeal process.
Information on how to appeal is often included in the denial letter from the insurer. If the information is not included in the denial letter, the patient can write to the insurer and request the information (see sample letter). It is best to appeal any denial by an insurer as soon as possible. Many insurance companies place limits on how long appeals may be filed following the denial of a claim.
Any time you contact your insurance company, record the time and date of your call and the name and job title of the person with whom you spoke. You should also keep a record of any contact with your doctor and conversations you have with your employer about your insurance.
The Psoriasis Foundation can provide you with a letter supporting your claim; however, it is very important to get your doctor involved. A sample letter your doctor can modify for his/her own use can be found here. Having your doctor write a letter is also important because s/he can describe your condition, whether or not a certain treatment is medically necessary and the types of treatments you have already tried.
If your insurance company has denied your claim for treatment and you would like a request a letter of support from the Psoriasis Foundation please e-mail advocacy@psoriasis.org and provide your name and address, the name of your insurance company, your patient ID number, the name and address of the insurance company's medical director/appeals department and a brief description of the situation. We cannot help until we have this information.
I tried appealing, but my insurance company is still denying my claim. What do I do now?
In addition to the internal review of appeals conducted by a health plan, many states also conduct "external reviews" or "independent reviews." Once an individual has exhausted his/her avenues for appeal within the health plan, most appeals are eligible for external review by the state. Specific information and instructions for applying to your state's review program can be found through the Kaiser Family Foundation or the National Association of Insurance Commissioners.
A template letter to send to the state insurance commission can be found below.
Sample letters
The Psoriasis Foundation has prepared sample letters that you can edit and send to an insurance company or your state insurance commission. You may copy or print these letters to use as a model. Note: These letters are only examples. Please edit each letter to suit your needs.
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