OHA: Helpful Hints

Coverage Problems

Helpful Hints

  • Gather your information.
  • Keep a record of all letters you receive from your managed care plan.
  • Keep a log of all telephone calls you make or receive related to your denial.
  • Keep a copy of the denial letter (do not assume your health plan will have it on file).
  • You need also to make sure you have a current copy of your plan's health insurance booklets and plan summary or member contract. These documents will not only contain a description of your benefits but also the procedure to follow to initiate an appeal or grievance.
  • If you have received a denial for a procedure that has already taken place and there are bills that are unpaid, you need to begin to backtrack to find out why. For example, does your plan require certain procedures to be pre-authorized; if so, did your doctor's office pre-authorize the procedure?