Help pack a million meals for struggling seniors on 9-11. Volunteer today


AARP Staying Sharp: Keep Your Brain Healthy


The tablet with free 24/7 customer support. Learn More


Military and Veterans Discount



AARP Games - Play Now!

AARP Books

Medicare for Dummies book cover

Get the answers you need, from Patricia Barry, AARP's Ask Ms. Medicare

Share Your Thoughts

Reader stories help us fine-tune our education efforts and strengthen our calls for action on issues that matter most to you. We read and learn from every story and may use yours (with permission) to brief legislators, inspire other readers and more. Please share your story with us. Do

Most Popular


In the News

New Rules Help Consumers Challenge Health Claim Denials

Health Claim Form

— Tetra/Getty Images

Fighting back when your health insurance company denies a claim just got a little easier, thanks to federal rules recently issued under the health care overhaul law.

The new regulations expand consumers’ rights to appeal denials, including the right to an independent, external review board. Consumers can also use the appeals process when their coverage is canceled.

Previously, rules regarding a patient’s right to appeal varied by insurer and state. The change creates consistency in the appeals process and—for the first time—extends the external review guarantee to employees of companies that offer their own health plans without contracting with an insurance provider.

The regulations will apply to new health insurance plans starting Sept. 23.

“Until the [health care law] reform, only a select number of states honored external review,” says Erin Moaratty, a spokeswoman with the nonprofit Patient Advocate Foundation (PAF), which helps patients navigate the appeals process. “Now every state is required to have a process for external appeals.”

The Hampton, Va., foundation helped Rona Dondzilo, 60, of Spokane, Wash., get an external review after she had been denied coverage for treatment of endometrial cancer. “The insurance company said it was a preexisting condition because I had been spotting before I was diagnosed,” Dondzilo explained.

She appealed using the insurance company’s internal process, then turned to PAF to help her get an external review. She eventually won.

To date, external review boards have reversed about 45 percent of appealed denials, according to the Kaiser Family Foundation.

In order to successfully overturn a denial, Moaratty stresses, consumers must keep careful track of paperwork and phone calls. The three most important tips PAF tells its clients:

Keep records. In a notebook or binder, carefully write down the date and time of each call to your insurer, whom you talked to and what you discussed.

Watch deadlines. Make sure you meet the insurance company’s deadlines for filing an appeal. The deadlines are spelled out in the insurance contract. If you miss a deadline, it may be impossible to file an appeal.

Follow up. Don’t assume that something will be done just because you made a phone call or sent a fax. And if you mail information to the company, make sure you send it certified so that you get a receipt showing it was received.

Remaining determined is also key, says Dondzilo.

“People get a denial and think they won’t win, but they need to take it as far as they can,” she says. “It’s their right to keep pursuing an appeal.”

Candy Sagon writes about health and nutrition for the Bulletin.

Topic Alerts

You can get weekly email alerts on the topics below. Just click “Follow.”

Manage Alerts


Please wait...

progress bar, please wait

Tell Us WhatYou Think

Please leave your comment below.


Discounts & Benefits

From companies that meet the high standards of service and quality set by AARP.

Walgreens 1 discount membership aarp

Members can earn 50 points per $1 spent on select health & wellness products at Walgreens.

member benefit aarp hear usa

Members save 15% on easy listening devices and more at the HearUSA Hearing Shop.

Eye Med 4 Membership Benefit AARP Discount

Members save up to 60% on eye exams and 30% on glasses at Target Optical.

Membership Benefits Discounts Email Genius

Brain boost? Get AARP email for access to memory exercises & more that help you focus.

Rewards for Good

Your Points Balance:

Learn More

Earn points for completing free online activities designed to enrich your life.

Find more ways to earn points

Redeem your points to save on merchandise, travel, and more.

Find more ways to redeem points