http://www.patientadvocacy.com/appeals.htm
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[] A primer for patients by the Patient Advocacy Coalition Colorado Ombudsman for Managed Care:
Start by asking yourself these important questions.
* Do you need a referral from your primary care physician in order to see a specialist?
* Do you need prior authorization for a planned surgery or hospital stay?
* Do you have to select a physician from a specific network for the charges to be fully covered?
* Are you in a point of service plan? If so, how does it work? What does your plan cover?
* What does it limit or exclude?
If you are enrolled in a health maintenance organization ("HMO"), you need to familiarize yourself with the rules of your particular HMO. If you learn the basic rules, and are careful to follow them, you can avoid most denials. However, there are some denials that cannot be avoided. Here's what you need to know if you receive a denial of coverage for treatment:
[ Go to the above website for more information about the following: ]
I. WHAT IS THE REASON FOR THE DENIAL? ( Go to website for information.)
II. WHO ISSUED THE DENIAL?
III. HOW CAN I CHALLENGE THE DENIAL?
IV. WHAT ABOUT MEDICARE, MEDICAID AND SELF-INSURED PLANS?
DON'T GIVE UP! Although the process may require a significant amount of effort on your part, it is a worthwhile endeavor to remain in control of your health care, and to challenge decisions affecting your health care with which you disagree.