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Do I Have the Right to Appeal a Claim Denial?

Attorney Mark Rufo PC

It can feel crushing when your New Hampshire health insurer will not pay to cover your medical bills for a significant personal injury or even a minor health issue. While you are trying to recover your health, you do not need to fret over whether you will receive the treatment you deserve. Fortunately, having your claim denied is not the end of the road by any means. In fact, federal law dictates that you have the right to appeal it.

Very Well Health explains that the Affordable Care Act guarantees the right to appeal a decision by your insurer to deny your claim. In fact, you have a number of ways you can appeal a denial. You can have your insurer process an internal appeal of your denial. In the event your insurer still does not approve your coverage, you can ask for an external appeal of your denial.

Your right to appeal includes coverage claims you make before and after you receive medical care. In other words, you might seek an authorization of coverage from your insurer for treatment that you have not even received yet. In the event your insurer turns you down, you can use the appeals process to seek pre-authorization of your care.

However, there are exceptions to a right to appeal. The Affordable Care Act grandfathers health plans that were in effect before the ACA was signed into law. So if your health insurance policy dates back prior to March 23, 2010, it is excluded from ACA’s right to appeal. Still, this does not mean there are no other options available to seek a reversal of your claim denial.

The information in this article is presented only for educational purposes and does not constitute legal counsel.