I often have to counsel families to appeal denied claims, especially from mental health insurers who are hired by larger health plans to “administer” mental health benefits. In my experience they are there to deny claims, rather than coordinate care, facilitate access to treatment, or assist families to select appropriate providers (other than those providers who are contracted with that insurer). That would actually be useful.

This is an area of the private insurance marketplace that is in desperate need of reform, but in the meantime the following New York Times article does an excellent job of describing the steps it takes to prevail in your appeal of a denied claim. Most importantly: don’t give up! It’s far too easy to feel as if an appeal is simply a waste of time. But in fact appeals do often work (as the article clearly point out) but it is worth remembering the insurance policy is yours, not your provider’s. Responsibility ultimately rests with you to appeal an incorrect or unfair denial and if you can’t face the prospect of a prolonged fight with the insurer, no amount of letter writing by your provider will help.

As our families know Kartini Clinic’s business office has and continues to advocate effectively for our patients in the face of unrelenting pressure to cut corners in the payment for treatment of eating disorders. We do our utmost to help. If you need assistance please don’t hesitate to contact our business office for help. We also have a section on insurance on this site. Just remember, in the end, only your own determination and perseverance will get the job done!