Claim Appeals
If a health insurer does not require a prior authorization for an item or service, and does not provide a predetermination of coverage decision, the physician or the patient must wait until a claim is considered by the insurer to understand if coverage will be granted. The provider or the patient can appeal an unfavorable coverage decision after a claim is denied.
Medicare Part B will consider appeals only after a claim has been filed; however, almost all health insurers have a claim appeal process that can be accessed to address claims that are denied coverage.
Please contact Destination Access at 1-800-861-0048 for templates on what to include with your claim appeals request.