Top strategies:
1. Understand the payer dynamics. Consider whether the plan is self-funded or fully insured. Self-funded plans or plans where the employer is responsible for claims payments are governed by the Employee Retirement Income Security Act.
2. Use strong language to support your stance. References to state laws, federal laws and court rulings and judgments can strengthen an appeal.
3. Obtain a certificate of coverage or explanation of benefits. If you can acquire one of these with relative ease, use the document’s language to defend your appeal.
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