Appeal the denial
For help with writing an appeal, see our example for a mental health and substance abuse appeal letter.
- You should use your right to appeal.
- Your insurer must send you a written explanation about why they denied the service.
- If your life or health is at risk, your insurer must make an expedited decision within 72 hours, however, 24 hours is preferable.
- If your insurer denies your appeal, you have the right to ask an independent review organization (IRO) to review the decision.
How to ask your insurer for more information
If your insurer's explanation doesn't have enough information, you or your provider can fill out the Mental Health and Substance Use Disorder Parity Disclosure Request form. This form can help you ask for more details about:
- Treatment limits, like preauthorization requirements for both medical and mental health treatment.
- Why your insurer denied benefits. For example, you can ask how they decided your treatment wasn't medically necessary.
After your insurer receives the form, they have 30 calendar days to respond. If you don’t receive a response within 30 days, you can file a complaint with our office.
When to file a complaint with us
You can file a complaint with us for any service or treatment issue, such as:
- Accessing providers on your health plan's network
- Benefit limits
- Denial of services
- Denial of prescription drug step therapy (trying alternative medications before the one your provider recommends)
- Denial of telemedicine appointments