Appealing an insurance decision
If your insurance denies coverage of your treatment, sometimes it’s hard to know what to do next. But if your insurance company refuses to pay a claim, you have right to file an appeal. After all, nothing should stand in the way of you and your prescribed treatment!
The resources on this page are designed to:
- Help you understand the steps in the insurance appeals process
- Identify reasons why your insurance company might not be covering your treatment
- Provide you and your physician with template letters to help you be successful in your insurance appeal
- Connect you to an NPF Patient Navigator for one-on-one assistance
Contact a Patient Navigator
If you’d like one-on-one assistance, an NPF Patient Navigator can help. We’ll share the appropriate template appeal letters and guide you through the appeals process.
Tell us a little about yourself, and a Patient Navigator will get in touch with you.
Know what you need? Download a sample letter, which can be used to appeal your specific insurance denial.
Letters for patients
Letters for health care practitioners
- Sample letter appealing the denial of a claim (general)
- Sample letter of medical necessity (LMN)
- Sample letter recommending home phototherapy unit
- Sample letter recommending treatment for palmoplantar psoriasis
- Sample letter recommending change in treatment with biologics
- Sample letter requesting formulary exception
- Sample letter requesting tiering exception
If you live in one of 19 states where NPF has passed legislation to protect you from step therapy, we have a specialized letter for you. Step therapy is when your insurance requires you to try a different treatment before approving the one your doctor prescribed.
To learn more, contact an NPF Patient Navigator.