IF YOU ARE DENIED COVERAGE
If your plan provides mental health benefits, it must use the same rules for determining coverage of mental health, including addiction services, as they do for physical health services. If you have been denied coverage or are having issues with your health plan, follow the three steps below and/or call the RI Insurance Consumer Hotline at 401-270-0101.
Talk with your primary care doctor; she or he are often your best advocate. If your health plan won’t pay your claim because they say it is not ‘medically necessary,’ your doctor or mental health professional has the right to speak to the person who denied the claim.
Call the customer service number on your insurance card to speak directly to your health plan. Ask them why, specifically, they have denied coverage for the recommended service. In writing, tell them you want to file an appeal. You have a right to appeal any denial of coverage with your health plan. Tips For Talking To Your Insurer
If you are not satisfied with your health plan’s response, or need help with your appeal call the RI Insurance Consumer Hotline housed at the RI Parent Information Network at 401-270-0101. The RI health insurance consumer hotline is hosted by the RI Parent Information Network and is available to every Rhode Islander regardless of health insurance plan.