American College - Center for Special Needs

What to Do When The Insurance Company Says No

Families may not know that they have options when a private health insurer or Medicaid denies a claim or reduces or eliminates a service.

BY Lauren Agoratus, M.A. | August 2019 | Category: Healthcare

What to Do When The Insurance Company Says No

There can be both internal and external appeals processes depending upon the type of plan. An internal appeal is a second look by the insurance company by representatives not involved in the original decision. An external appeal is when a neutral third party independently reviews the documents. 

 Services needed by children with special health care needs can be medically necessary, required under the Individuals with Disabilities Education Act, or both.

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