If your health plan denies a claim, you have the right to appeal the denied claim.
- This means you can ask your health plan to look again at its decision, and perhaps reverse the decision and pay the claim.
- Call your health plan to ask how to submit a request to appeal a claim.
If your health plan still denies the claim after your appeal, MID may be able to review the denial.
- This is called an External Review. It is a free process for consumers where an outside healthcare provider reviews your claim and makes a final decision on medical necessity, appropriateness, healthcare setting, and level of care or effectiveness of the treatment received.
- Requests must be made within 120 days after the denial. Fill out the External Review Request Form here.
To learn more about benefits and the appeals process, go to: