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Doctors and Insurance

What to Do If You're Denied Coverage for Your Crohn's Treatment

Some kinds of rejection are harder to take than others. When you’ve been denied coverage for Crohn’s treatment that could mean the difference between effectively managing your Crohn's disease or living in pain, rejection can be devastating.

According to the Advocacy for Patients with Chronic Illness and the Office of the Healthcare Advocate, 96% of insurance denials are never appealed. But those that are appealed have a success rate as high as 80%! So, don’t give up before you’ve started. Your course of action will vary based on the type of insurance you have, but follow these tips.

  • Determine why your Crohn’s treatment claim was denied. Don’t try to guess the reasons why your insurer denied your claim—they may be related to medical necessity stipulations. Your appeal will be based on the reason for denial, so get the information and then develop a plan of attack.
  • Get your paperwork in order. Once you’ve figured out the reason for denial, gather necessary documents – medical records, journal articles, and letters from your doctor explaining medical necessity to help make your case.
  • Write a letter of appeal. While it might be tempting, calling your insurer to plead for medicine won’t get you far. Write a compelling letter about your situation, using the documents you’ve gathered as attachments that provide evidence to make your case. The better and clearer your explanation, the more likely you are to win.

For more information on appealing an insurance decision, visit the Advocacy for Patients with Chronic Illness Web site.