There are several reasons a claim can be denied or partially approved. (See "Understanding claim denials" for the common ones.)
Know why it was denied? Fix it and resubmit
If you know what needs to change, or want to add additional documentation, you don't need to appeal. You can submit a new claim instead, for the full amount if it was fully denied, or just the amount that wasn't approved if it was partially denied.
Filing a formal appeal
You can formally appeal a denied or partially approved claim in writing. Review your plan rules to confirm your appeal meets any deadlines set in your plan documents. Your plan administrator will review your appeal within their designated timeline and notify you of the outcome.
Before you appeal, reach out to support
Contacting the support team first can often resolve questions about your specific decision faster than a formal appeal.
Timeline
All appeals must be communicated by email at [email protected] within 30 days of the original decision.
Decisions on appeals will be sent within 30 days.
Here's what to take note of:
The review will show no deference to the initial decision.
Customer or authorized representative may submit written comments, documents, records, or other information relating to the claim for benefits, and, upon request and free of charge, will be provided reasonable access to, and copies of, all documents, records, and other information relevant to the claim for benefits.
The plan fiduciary who considers the appeal will take into account all information submitted, regardless of whether it was submitted or considered in the initial decision.