Insurance Appeal
Also called: Claim Appeal, Grievance
In plain English
The formal process of asking your insurance company to reconsider a denied claim. You have the legal right to appeal any denial. There are typically two levels of internal appeal, followed by an external review by an independent third party.
Real-world example
Insurance denies your physical therapy visits as 'not medically necessary.' You file an internal appeal with a letter from your doctor explaining why the therapy is needed. If denied again, you can request an external review by an independent reviewer.
Why this matters for your bill
About 50% of internal appeals are successful, and external reviews overturn denials even more often. Most people never appeal because the process seems daunting — but it's your legal right and it works more often than you'd expect.
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