QUESTION

I was denied coverage for a service my doctor said I need. How can I appeal the decision?

Post enrollment issues | Individual Health Insurance |
ANSWER

If you are enrolled in an ACA-compliant plan, you will have 180 days (six months) from the time you received notice that your claim was denied to file an internal appeal. The “Explanation of Benefits” (EOB) form that you get from your plan must provide you with information on how to file an internal appeal and request an external review. If your plan is fully insured, you can get help filing an appeal from your state's department of insurance. Your state may have a program specifically to help with appeals. (HealthCare.Gov, Internal Appeals.)

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Post enrollment issues