We help you with 100% of the appeals process. We not only prepare your appeal letter, but fight with you every step of the way, including additional paperwork that may be required, and internal and external reviews. Once you’ve filled out the form and submitted the receipt, your appeal is in our hands, and we've got you covered!

Lucky for you, we are not! Health insurance lawyers often charge high hourly rates, and/or a large upfront fees even before you know if you have a chance at winning your appeal. At Covered, you only pay us once you’ve won your appeal. If the appeal is unsuccessful, there is no charge to you.

We built Covered to help Americans fight and win their health insurance appeals. Insurance companies have benefitted from a confusing, complicated, and painful appeal process for far too long. At Covered, we’re experts in how the appeal process works and we make sure that we file your appeal in a way that maximizes your chances of getting your money back. Plus, because you usually have just one shot at getting your appeal right, it’s important to get it right the first time. So, again, we've got you Covered.

For internal appeals, your health insurance company must make a decision (or at the least, respond) within 60 days if you are appealing a service you've already received. If you have yet to receive the service, and it’s a pre-authorized denial, your health insurance company must make a decision within 30 days. For external appeals, decisions are typically made within 45 days of receiving the request. In some cases you may be able to expedite the external review and receive an answer in less than 72 hours. We do our best to ensure you hear back as quickly as possible. At Covered, our interests are fully aligned with yours - we only get paid if and when you get paid!

Usually, your health insurer will permit only one request for external appeals.

While the process of fighting a medical claim denials varies from state to state, here are a few of the basic steps: Find out why the claim was denied. You should receive an explanation in the mail. If you do not, you can call your insurance provider to discover the reason. However, in our experience, the answer you get on the phone is not always the same as one you get once you appeal the denial, so it is best to get an explanation in writing. Review your plan policy. Once you have a written explanation for why your claim was denied, you may want to reference that explanation against the terms of your health insurance plan to make sure the terms were not violated. File an internal appeal. If you believe your claim has been wrongfully denied, you can request to file an internal appeal with your health insurance provider. This process differs from company to company, and from state to state. File an external appeal. If you have been unsuccessful with an internal appeal(s), you can take your appeal to a third-party reviewer. Many states offer external reviews, as does the federal government’s Department of Health and Human Services (i.e. for Medicare and Medicaid). Fighting an insurance claim denial can be a time-consuming and exhausting process, especially if you are handling it alone. That’s why we recommend using Covered.

While a claim can be denied for many reasons, at its core, a denied claim is the health insurer stating that the service an individual received/is requesting to receive does not fall under the health insurance plan's rules of coverage. Here are a few reasons that a health insurance provider might provide as explanation for why they are not responsible for paying a claim: Prior Authorization Was Required: A claim may be denied because prior authorization from the insurance provider was required, but the request was not submitted before the service was received. Missing or Incorrect Information: Mistakes happen! When there are errors in a claim form—such as a misspelled name or missing piece of paperwork—a denial is likely. That is why it is important to double and even triple check information on your claim form and make sure that is it is filled out completely if you are the one submitting it. Outdated Insurance Information: Claims can be denied due to outdated insurance information, such as sending a claim to the wrong insurance company. Claim Was Filed Too Late: Most insurance companies have a window (6-months to one year) in which they will accept claims. If you wait too long and miss the window, your claim is likely to be denied. Services Not Covered: There can be exclusions to your plan and some procedures may not be covered by your policy, or there may be a limitation to the number of visits for a particular service.

A health insurance claim is a request submitted to your health insurance provider – usually by your health care provider, but sometimes by a patient/patient advocate – that seeks reimbursement for the cost of the care/services received. For example, if you go to your primary care doctor for an annual check-up that involves a blood test and a vision test, your doctor’s office will submit a list of costs to your insurance company for each service that was provided. Your insurance provider will then determine what percentage of the costs you will be responsible for based on the co-pay (that's the flat amount you pay for every visit), deductible (that's the dollar amount you have to pay before your insurance company starts paying), out of pocket maximum (that's the maximum amount you will have to pay in a calendar year), and coverage of your plan. They will then pay the rest of the claim bill.

Denied claims have to be appealed to your insurance provider first. If that is denied (sometimes twice), then a separate appeal must be filed with your state insurance review board. Most insurance providers will provide a response within 30-45 days. State review boards generally respond within 30-60 days.

In order to represent you with your insurance provider, we will need your basic information (name, email, contact info) plus a copy of your insurance card (front and back), and copies of any correspondence with your insurance provider, in addition to your medical receipts.

There are a lot of variables that come into play to determine the potential reimbursement of a claim: the type of claim, what stage you are at in the process (appealing to insurance provider or state), reason for the denial, coverage information (deductibles, coinsurance, etc.), exclusions, whether it’s a state or federally governed plan. Unfortunately, no one has a crystal ball and we cannot win every claim but our experience shows that we can get reimbursement for the majority of denied claims that we handle.