When an insurance carrier denies a claim, they will indicate whether they believe it is the patient's responsibility to appeal the denial, or Mayo Clinic's responsibility to appeal the denial.
Mayo Clinic will appeal every denial that is indicated as our responsibility, and as a courtesy to our patients we appeal denials over $2,000 even when the carrier indicates it is the patient's responsibility. In these instances, Mayo Clinic will contact our patients to have them assign the right to appeal to us. This will require the patient to complete a form with their carrier to indicate they authorize Mayo Clinic to appeal on their behalf, which a Mayo Clinic representative will walk through during an outreach phone call.
For patient responsibility denials under $2,000, patients will need to work with their insurance carriers to determine what forms they will need to complete to appeal.
Generally, appealing a claim as a patient may involve steps such as: obtaining medical records from the patient portal, demonstrating that authorization was obtained prior to services or updating coordination of benefits (COB) information with the carrier. It also often will involve completing an appeal form that is unique to your carrier and, as such, working directly with your insurance carrier will be the fastest way to get your claim appealed, paid and resolved.
Helpful hints for insurance claims appeals
- You can submit at least three levels of appeals with your insurance company. Contact the company for more information regarding its specific appeal procedures.
- Contact your insurance company and ask for a copy of your health insurance policy.
- You have the right to contact your state's insurance commissioner to assist in the appeal process. Commissioner contact information: https://content.naic.org/state-insurance-departments
- In most states, appeals at your request can be reviewed by an external party, such as an independent medical review panel sponsored by the state.
- You can also contact the attorney general of your state.
- Links to sites that can assist you with appeals: