Appeal
In the healthcare industry, an Appeal is a formal request made by a patient or healthcare provider to a health insurance company to review and reconsider a denied claim or a decision about coverage. When an insurance company denies payment for a service, treatment, or medication, the affected party can file an appeal to challenge the decision.
The appeal process typically involves submitting a written request, along with any supporting documentation, such as medical records, letters from healthcare providers, or additional information that justifies the need for the denied service. The insurance company then re-evaluates the claim in light of the new evidence. There are generally multiple levels of appeal, starting with an internal review by the insurance company. If the internal appeal is unsuccessful, an external review by an independent third party may be requested.