Appeal
Fix it without an appeal
Get a corrected claim resent, ask for reprocessing, or have your doctor speak to the plan's reviewer.
Do this today
- Use the tool: Call script builder Get the words to say, what to ask for and what to write down before you phone your plan or provider.
- Read: Before you appeal: corrected claims and reprocessing 5 minute read. When a denial comes from a paperwork mistake, a corrected claim or a reprocessing request may fix it faster than an appeal. Here is how to try that safely without losing your appeal deadline.
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Put this step on My Plan
So you can come back to it, and keep your dates and calls in one place.
In brief
- Some denials are mistakes in the paperwork, such as a wrong code, a missing detail or a duplicate claim, and a corrected claim can fix them.
- Ask for the diagnosis and treatment codes in writing. Asking for them is not an appeal and does not start or stop any clock.
- Fixing a claim does not pause your deadline to appeal unless the plan tells you so in writing, so keep the appeal ready.
Read the full guide: Before you appeal: corrected claims and reprocessing
More guides, tools and letters
More guides, tools, letters 8
Guides
- Before you appeal: corrected claims and reprocessing
When a denial comes from a paperwork mistake, a corrected claim or a reprocessing request may fix it faster than an appeal. Here is how to try that safely without losing your appeal deadline.
Tools
- Tool
Call script builder
Get the words to say, what to ask for and what to write down before you phone your plan or provider.
Letters and scripts
- Letter or script
Appeal: coding error and reprocessing
Asks your plan to reprocess a claim that was denied because of a billing or coding mistake, after your provider has corrected and resubmitted it.
- Letter or script
Ask your plan to reprocess a claim under the No Surprises Act
Ask your plan to reprocess a claim with the No Surprises Act protections, so you pay only in-network cost sharing that counts toward your in-network limits, and to treat the letter as an appeal if the claim stays denied.
- Letter or script
Peer-to-peer call brief (for your clinician)
A one-page set of notes in your clinician's voice for a call with the plan's reviewing doctor: the three points to make, the questions to ask and what to record. Every clinical statement is a blank for the clinician to complete.
- Letter or script
Phone script: ask for a peer-to-peer review
What to say to your doctor's office and your plan to ask for a call between your doctor and the plan's reviewing physician.
- Letter or script
Phone script: ask for reprocessing
What to say to your plan and to the provider's billing office to get a paperwork denial corrected and the claim processed again.
Programs and services
- Program or service
Veterans Affairs patient advocate program
Every VA medical facility has a patient advocate who handles concerns from veterans and families. The advocate can help with a care problem and, if needed, help you file an appeal.
From U.S. Department of Veterans Affairs, Veterans Health Administration
Questions to keep handy
- What exactly was denied, and under which part of the plan?
- What is my deadline, and what is it counted from?
- Where and how do I send my request, and how will I prove it arrived?
- Who decides, and can I ask for a faster decision?
Not what you need? Find a person who can help, or search the whole site.