Appealing Health Insurance Denials
If you receive a claim denial and do not agree with the decision, consider appealing the denial. Go back and review the patient's insurance policy for coverage information. The explanation of benefits (EOB) letter from the health plan is the key to payment or denial status. If the coverage language supports payment, write an appeal letter describing the disorder and its medical nature, and reference the coverage policy paragraph that shows how your treatment fits coverage criteria.
Speech-Language Pathology Related
The health plan may conduct an internal review of the denial. If all levels of appeal are exhausted, and you still believe your treatment meets coverage definitions, consider taking the case to the external claim review level. Currently, 42 states have an external review process (go to the Kaiser Family Foundation's website to see each state's procedure and contact points).
Letters Sent by ASHA
This letter to Premara Blue Cross of Washington [PDF] is an example of the types of letters sent to health insurance companies by ASHA.
Contact ASHA's health care economics and advocacy staff at [email protected] for assistance with appeals related to audiology and speech-language pathology services.