Even though health insurance companies are required by law to cover mental health treatment, claim denials are still common. If you’re struggling to get mental health services paid for by insurance, read on!
Appealing a Denied Mental Health Claim: Step by Step
Once you’ve received a denied claim, the responsibility for your mental health bill falls on you. Your first course of action is to appeal the denial in the hopes that your insurance company will reconsider their decision and cover the bill. The appeal process is the same for mental health claims and physical health claims, but it does differ depending on your specific state, insurance company, and plan. Here’s what you can expect:
How Do You Appeal a Denied Blue Cross Blue Shield Mental Health Claim?
Blue Cross Blue Shield is one of the biggest health insurance providers in the US. The exact steps you must go through and deadlines you must meet depend on your state and type of plan, but here are the basics:
- Contact Blue Cross Blue Shield. Call the member services line and provide a customer service representative with your member ID. Tell the representative that you’d like to appeal a denied claim. When you are on the phone with an agent, ask what documentation you’ll need to include with your appeal and be sure to take notes. Expect extended hold times and prepare yourself to get shuffled around among different departments before you’re able to speak with someone who can answer your questions!
- Submit a Written Appeal. Blue Cross Blue Shield requires written appeals in most states. Fill out and send an appeal request form within 180 days of receiving notification of the denied mental health coverage. Include all required documents.
- Receive a Response. Within 15 days, you’ll receive notice that Blue Cross Blue Shield is processing your appeal. Within 30 days, you should get a response. Either your insurance provider will reverse their decision and cover the mental health claim, or they’ll stand by their previous denial. If you are unsuccessful, you may be eligible for an external review, in which case Blue Cross Blue Shield will provide you with instructions on how to file one. In an external review, a third-party organization (either your local government or an independent reviewer) will look over the appeal and make a final decision.
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How Do You Appeal a Denied Claim From Aetna?
Aetna’s mental health claim appeal process requires that you submit an appeal over the phone with member services or by mail within 180 days of denial notification.
Some Aetna plans allow for one internal appeal and some allow for two, so ask a customer representative what the process will look like for you. If your plan allows for two appeals, you’ll be able to push for further review even if your first attempt is not successful. The time it takes for a decision to be made depends on which kind of plan you have. This insurance company also expedites the review of denied urgent care claims, so if your mental health treatment required treatment at an emergency or urgent healthcare facility, you can expect a faster response.
With so many options for denied claim appeals, the challenge with Aetna is understanding the system in your state and for your plan well enough to increase your chances of a successful outcome. Plus, if your appeal doesn’t work, how do you know what to do then?
How Do You Appeal a Denied United Healthcare Claim?
United Healthcare’s mental health claim appeal process depends on your state and the plan you subscribe to. In most cases, you have the option to file a standard or expedited appeal depending on the urgency of the claim. Some plans allow for two different levels of internal appeals before you can request an external review. The first level is an informal appeal, which can take longer than a formal appeal and is processed by professionals within United Healthcare. The second level is a formal appeal, which often involves a peer-to-peer review with your mental health provider.
These appeals are typically sent by mail and can be submitted either by you or your mental health provider. To ensure that this appeals process applies to you, call United Healthcare and ask.
But how do you know if it makes sense to file an expedited appeal, and how can you improve your chances for the second internal review? That’s why it isn’t ideal to fight a mental health claim alone—there are just so many ways the process can go wrong!
How to Get Help With a Denied Mental Health Claim
When you get to the point in the mental health denied claim process where you feel overwhelmed, it’s time to call in an expert. The many factors that go into a successful denied claim appeal make it not worth the risk of taking it on by yourself—get aJust on your side and let them navigate the maze of denials and appeals to lower the amount you owe.