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Claim denied? Here's what to do

Internal appeals. All insurance companies must allow customers to appeal denials made on the grounds of “medical necessity.” In most cases, rehab center staff handle these appeals, which must be made within 45 days of the denial. Expedited appeals can be granted case-by-case.

External appeals. The state Insurance Department will examine the case upon request if the claim is denied on internal appeal. The department overturns denials about 45 percent of the time. The department’s external appeal phone number is 800-400-8882.

Complaints: You may file a complaint about an insurance denial using a form at ins.state.ny.us/complhow.htm.
State Attorney General’s
office: The health care bureau looks into some insurance complaints: 800-428-9071.

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