Some appeals are simple and require only a statement of the facts and the basic reasons why you believe the condition or treatment should be covered by the health plan. For others, however, more information is necessary. You may want to consider the range of information listed below, such as medical literature, treatment guidelines, expert opinion, and more. While you want to find information that supports your appeal, don't be afraid to include material that disagrees with your position or compares both sides of the issue.
Experts sometimes have different opinions as to the most appropriate ways to care for a patient.
Understanding all of the options will help you present your best case. It will also help you know you are on the right track for getting the best care. Clinical Information Clinical information reviews health conditions and specific treatments. It is based on observing you or patients in similar situations. This kind of information may strengthen your appeal.