What to do if you receive a denial from your insurance company
By now, most residents have heard or read about a number of insurance denials from Kaiser Permanente associated with air medical transports by either Airlift Northwest or Island Air. County leaders are continuing to work with Kaiser Permanente and the Washington State Office of the Insurance Commissioner (OIC) to resolve questions related to coverage for emergency air medical transport.
Regardless of the outcome of this work, the San Juan County Board of Health wants all residents to understand how to appeal a health care claim denial. Appeals are generally made up of the following three phases:
Phase 1: Denial of request for service, payment, or coverage
Phase 2: Internal appeal to your health plan or carrier
Phase 3: External appeal to an independent review organization
The OIC has developed a guide on How to Appeal a Health Care Insurance Decision. This guide contains very useful information including; where to start, step by step process, tips for drafting an appeal, sample templates and letters, keeping track of your communications and other helpful material.
You may also choose an authorized person or your medical provider to act on your behalf. Nearly all medical providers have patient advocates to assist with the appeal process. Contact your medical provider for specific information. For anyone who has experienced an air medical transport denial, both air operators have customer service representatives to assist you. Please contact either Airlift Northwest at 866-245-4373 or Island Air at 360-378-2376.
Finally, as a consumer, if you experience a denial from your insurance company for any covered service, it’s a good idea to contact the Office of the Insurance Commissioner. The Insurance Commissioner’s office answers hundreds of insurance questions every day, and you can easily file a complaint against your insurance company on their website. You can also call the toll-free Insurance Consumer Hotline at 800-562-6900.