Track Your Health Insurance Appeals With This Correspondence Tracker

Trying to appeal a health insurance denial can feel defeating. (Trust us, we’ve been there). After a few calls, it can be tempting to throw in the towel. But, it’s worth sticking with it, says Adam Fox, deputy director of the Colorado Consumer Health Initiative, a non-profit health advocacy organization. “This can be the difference of hundreds or often thousands of dollars that you could end up responsible for,” he says. 

One thing that can help make the process easier to navigate: Taking notes. That’s why we broke down how to keep track of your health insurance correspondence, and why it can make appealing an insurance claim easier. 

Information you’ll need to appeal an insurance denial

Fox says there are three things that may be helpful to have on hand when you start an insurance claim appeal: 

• Your explanation of benefits (EOB). You’ll likely receive your EOB after the health claim is processed. It will show what you and your health plan owe for the medical service. It may also have other details like the diagnostic code and the date and description of the service which will come in handy during this process. 

• An appeal form. You can call your health plan and ask if this is required for an appeal, says Brown. 

• An itemized medical bill. If your medical provider hasn’t already provided this breakdown of charges, now’s the time to call them up and ask for it. They may have coded your medical care incorrectly.

• A list of medications. If your insurer denies coverage of a certain medication, Brown suggests preparing a list of medications or treatments that you have been prescribed in the past as well as the ones you hope to receive. Make a note of why they did or did not help, and why the new medication or treatment will help. “A copy of any medical journal articles supporting the prescribed medication” may also be helpful, says Brown. 

• A Letter of Medical Necessity. If your insurer claims that your medical service, treatment, or medication is not medically necessary, you can request a Letter of Medical Necessity that proves otherwise. 

• Your policy coverage docs. These can be helpful because “you may be able to point out in those documents where the service should have been covered,” says Fox. 

Why it’s important to keep track of correspondence with insurers

Arming yourself with information and notes — like who you spoke with and the information they gave you — can help keep you from getting overwhelmed, stay organized, and communicate from one call agent to the next. The hardest part about getting a claim appealed or approved can be simply the persistence required to continue to get in touch with your insurance company until you make progress. 

“There are lots of moving parts and pieces to filing an appeal, including lots of paperwork and phone calls,” says Emily Brown, a patient education content and project manager at Patient Advocate Foundation. 

How to keep track of your correspondence

Brown recommends having one place where you can keep track of everything. Lucky for you, we made a Google Sheets template for exactly this. 

You’ll note who you spoke with, the date and time of the call, a reference number of the call if it’s available, and what you discussed. “If there are particular statements that they make, trying to write them down as close to verbatim as possible is helpful,” says Fox. “You'll be able to reference back to what you had been told previously.’”

theSkimm

Navigating insurance in any way can be complicated, let alone when there’s money on the table. So pat yourself on the back for doing a hard thing — and stay persistent.