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Insurance companies like your business because they like your money. Sometimes, insurance companies do not like paying money to you.
The Arizona Department of Insurance protects consumers in conflicts with insurers. The state offers an appeals process when an insurance company denies a request or claim.
You can appeal when your insurance company:
Appeals are not always possible. You cannot appeal a disagreement
over the amount of your copayment, rate increases or if a company decides not to insure you.
Either you or your provider can file an appeal. Under state law, you must first file an appeal with the insurance company. The state may get involved if you are not satisfied with the company’s response.
The appeals process depends on many factors. Chief among them is the urgency of your medical situation. Some conditions demand immediate attention. Others do not. Depending on the urgency, you can pursue either an expedited or standard review.
The process becomes complicated. Terms such as medical necessity and contract coverage may come into play. You need documentation and must meet deadlines.
The process can involve the insurance director reviewing the case. It can also include the Office of Administrative Hearings.
A good appeal
Insurance companies specialize in red tape. Their rules are complex. The government’s laws are also complex.
All you want is care for your medical condition. You can read through your policy and visit the state website for information, but it is far too easy for you to make a simple mistake that jeopardizes your appeal. When your health is at stake, always explore your options.