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Internal appeals | HealthCare.gov

internal appeals

There are 3 steps in the internal appeals process:

  1. You file a claim: A claim is a request for coverage. You or a health care provider will typically file a claim to be reimbursed for the costs of treatment or services.

    Reading: How to file an appeal for health insurance claim

    Your health plan denies the claim: Your insurer must notify you in writing and explain why:

    • within 15 days if seeking prior authorization for treatment
    • within 30 days for medical services already received
    • within 72 hours for urgent care
    • within 72 hours for urgent care cases
    • li>

    File an internal appeal: To file an internal appeal, you must:

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