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How to Protect Insurance Appeal Rights

Produced by Mental Health Legal Advisors Committee
Reviewed July 7, 2009

Don’t hurt your client's ability to get services!

Public and private insurers, under the guise of care management, sometimes deny necessary services to your clients. The right to appeal authorization denials rests with your clients. But clients lose that right if you, the clinician, don’t insist upon the services you initially requested.

Be aware:

Doctor to doctor reviews and conversations with utilization reviewers do not begin the appeal process.

Only the client or someone authorized by the client can initiate the appeal process, unless the client is in the hospital and the appeal concerns that hospital stay.

A denial notice precedes the beginning of the appeal process.

If you agree to or don't protest a reduction in services during conversations with the insurer or its staff, a denial notice will never be sent to your client and she will lose all appeal rights.

Help is available.
Call the Mental Health Legal Advisors Committee at (617) 338-2345 Ext. 29.

An attorney will advise you on managed care and parity issues, help you and your client through the appeal process and, in some cases, represent your client. Mental Health Legal Advisors Committee is a state agency within the Supreme Judicial Court and does not charge for its services.

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