There may be times when your insurance company says it won’t pay for a service you believe your child needs. You can appeal the decision, which means you are asking them to look at the information again and change their mind. 

Follow these steps

1. Get it in writing
   If someone tells you “no” on the phone, ask them to send you a letter telling you why.

2. Learn about the appeal process
   Each insurance plan has rules for appealing decisions. Ask for a written copy if you need it.

3. Understand why the claim was denied
   Common reasons a claim is denied include mistakes in how something was coded or the insurance company thinking a treatment is not needed or new and not proven.

4. Ask your doctor
   You can call your doctor’s office and ask them for information that can help fix the coding error or explain why a treatment is needed.

5. Write a letter
   In most cases, you will need to write a letter to start an appeal. Your insurance company may also ask you to complete a form. In the letter, explain why your child needs the treatment and include any information from your doctor. Be sure to address the reason they gave you for denying the claim and ask for a response in writing.

6. Keep good notes
   Write down details of any phone calls or conversations you have about your appeal. Include when the call happened, who you talked to, and what you discussed.

7. Save copies of all important documents
   Create a paper or electronic folder with your insurance policy, copies of letters, phone notes, and any other related records. Insurance appeals can take a long time. It’s important to have a record so you don’t have to try to remember everything.

8. Share copies
   It may help if you send your appeal letter to others who can help. This may include your doctor, your work’s benefits manager, the head of the clinic or hospital where your child receives care, or the person in charge of the insurance company.