Am I Eligible For An External Appeal If My Health Plan Denies Coverage Because I Have A Pre-Existing Condition Or Because I Exhausted a Benefit Under My Health Insurance Contract?
• No. Only medical necessity, experimental or investigational or certain out-of-network denials are eligible for external review. • If your health plan denies coverage for other reasons, you will not have a right to an external appeal, but you will likely have appeal rights with your plan. Check your member handbook and subscriber contract for information on how to appeal a denial with your health plan. • In addition, the Insurance Department’s Consumer Services Bureau is available to investigate any complaint you may have against your health plan. You can submit your complaint to the Insurance Department’s Consumer Services Bureau using our Online Consumer Complaint Form located on this Web site. For more information on how to file a consumer complaint, call 1-800-342-3736.
Related Questions
- Am I Eligible For An External Appeal If My Health Plan Denies Coverage Because I Have A Pre-Existing Condition Or Because I Exhausted a Benefit Under My Health Insurance Contract?
- I am changing from one type of coverage to another, but staying within the same employers group health plan. Can a pre-existing condition exclusion be applied to my new coverage?
- Do Americans already have the right to appeal if a health plan denies coverage for something?
