Taking the time and energy to write the necessary appeal of a denial of treatment can be daunting but necessary. If your doctor has recommended that you see an out of network specialist, or have a certain procedure which your insurer still views as experimental, you will have to meticulously document the need and the credentials of the specialists you want to see and the success rate of the procedure your doctor is recommending. Many people are finding success turning to artificial intelligence sources such as ChatGPT to both research and write these appeals, resulting in impressive multipage documents filled with technical referencesto medical journals that are often effective in winning appeals.

Bear in mind that the success rate on appeal is over 50% so the odds are in your favor if you do appeal . Send your appeal within the applicable deadline headlined in capital letters URGENT EXPEDITED REQUEST FOR RECONSIDERATION and send it to each of the top twenty executives for the insurance company and, if the insurance is funded by your employer and only administered by an insurance company send it to the CEO , CFO and other top officers at your employer as well, not just to the employee benefits department.In this way your appeal will receive extra attention because the people who actually read it will at least think the higher ups will be looking . All it takes is for one of these decision makers to react positively and it will be approved, so the more recipients the better. But no matter how brilliantly worded your appeal, you will lose if you merely send it to the post office box listed for the employee benefits department. Who you send the appeal to is no less important than what you say in it.

Also and concurrently with your appeal, reach out to your local TV station and newspaper and social media outlets for publicity on the initial denial which you are appealing . No company wants public notoriety but it can work in your favor. NBC TV nightly news for example regularly runs a feature called “Cost of Denial” which spotlights the plight of patients who have been denied treatment , and the newscast regularly provides follow up reports on the many subsequent reversals of these denials achieved following such publicity.

Also note that the administrators of self insured employer group benefits plans often state erroneously in denying claims that the government will not allow them to make exceptions to the rules and regulations governing such plans. This happened when an employee covered under one such plan failed to sign up her baby for coverage within 30 days of birth as required on the company website, despite her phone call in to the plan administrator’s office before that deadline. The mother was exposed to a huge maternity hospital bill. But employer self funded plans can always make exceptions to its own rules and regulations such as this 30 day notice deadline . The law just requires that any adjustments to their rules must be applied fairly to all members in the plan. The law even allows them to give greater exceptions to people with adverse health factors such as the documented medical complications that this new mother’s premature baby encountered. The denial was reversed after publicity by Pro Publica investigative journalist Marshall Allan. See his book Never Pay the First Bill as listed in the Resources section for further information. See also Laurie Todd’s book “Win Your Insurance Appeal in Five Days.”