Next steps should coverage questions remain:
- Ask the health insurance company to take another look at the claim. Each insurer has a specific benefit appeal process. Ask abut filing deadlines, required forms, and how to submit supplemental documentation to support reconsideration. Keep a written record of this discussion, including the person you talked to.
- Submit the necessary appeal paperwork. Keep a copy for your file and wait for the insurance company's response.
- If the denial stands, and it involves medical judgment, determination of experimental treatment, a pre-existing condition, or policy recission (except for nonpayment) consider having the Illinois Department of Insurance conduct an external review. IDOI can do an external review if you are covered by an individual or group health insurance policy issued in Illinois. An external review is not an option if you receive health coverage from a self-insured, union, church, or non-federal government plan. Also ineligibl are insurance policies issued in other states, specific disease, long-term care, disability, dental, vision, Medicare, Medicaid, federal employee, and military plans. Request an external review within four months of the insurance company's internal claim review response. Check IDOI's website for details on forms and other requirements. You will receive written notification of findings from the external review.