Understanding your health insurance

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Dealing with health insurance coverage denial

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There may come a time when your insurance company denies covering a treatment, procedure, or medicine your doctor recommended. This can happen before or after you have received the treatment, procedure, or medicine.

Steps to take if your coverage is denied

  • Contact your insurance case manager and ask why your claim was denied. They will be able to tell you if information is missing or if the treatment was denied for other reasons.
  • Ask your case manager about your insurance company’s appeal process and the steps you take to challenge a denial.
  • Talk with your doctor’s office and ask for the person whose job it is to handle appeals and provide records of your treatment and needs.
  • File an internal appeal, asking for your insurance company to review its decision.
  • File an external appeal by contacting your state’s insurance agency.

For more information about appealing denial of coverage, visit Triage Cancer’s Quick Guide to Appeals for Employer-Sponsored & Individual Health Insurance.

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Reviewed and updated: October 7, 2024

Reviewed by: Aimee Hoch, MSW, LSW, OSW-C, FACCC

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Living Beyond Breast Cancer is a national nonprofit organization that seeks to create a world that understands there is more than one way to have breast cancer. To fulfill its mission of providing trusted information and a community of support to those impacted by the disease, Living Beyond Breast Cancer offers on-demand emotional, practical, and evidence-based content. For over 30 years, the organization has remained committed to creating a culture of acceptance — where sharing the diversity of the lived experience of breast cancer fosters self-advocacy and hope. For more information, learn more about our programs and services.