Your Right to Appeal Insurance Claims

If your insurance company has not processed your claim correctly, it is important to take action. Insurance companies typically require a letter from the member to initiate claim reprocessing. Please complete the form below for each claim you wish to appeal. Note that separate letters are necessary for mother and baby claims, as well as for facility and professional claims.

1. To begin, fill out the form below by replacing the highlighted text with your information, including your name, address, the payer’s name and address, and other claim-specific details. Clear the signature field and sign your name before submitting.
2. Enter your email address to receive a PDF copy of your letter.
3. Print pages 1 and 2, and be sure to attach any supporting documents, such as relevant pages from your policy indicating maternity coverage or an explanation of benefits (EOB) if available for the claim you are appealing.
4. Once completed, you may submit the letter and supporting documents via mail, fax, email, or by uploading them to your insurance portal.

If your appeal letter doesn't result in the appropriate payment, visit File a Complaint Against Your Insurance Company.