![]() The first step in an appeal is called an internal review. It begins when you file a complaint to appeal a denied claim. Your claim will get a second look by insurance company employees who weren't involved in the original decision. If you are in an urgent medical situation, you can request an expedited appeal which requires the insurance company to make a decision within 72 hours.Īfter the internal review, your insurance company will call or send you a letter about its decision. If the insurance company overturns the initial decision, your care will be covered. If it upholds the decision, you still have other options. If you're not happy with the outcome, you can take it to the next level. People who don't work for your insurance company - called an independent third party - will do their own review. Usually, you will have four months from the denial of your internal appeal to ask for an external appeal.Some states and plans may have different deadlines. If you are in poor health, you may file for an outside review before the internal review is done.You may also request an expedited review if a decision is needed quickly for health reasons. In an expedited review, the external review organization must make a decision on your appeal within 72 hours. You can send in additional information to support your claim.Some plans require more than one internal review before you can submit a request for an external review.#AETNA TIMELY FILING LIMIT 2020 HOW TO#.
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