We understand that receiving a claim denial can be frustrating and stressful. At BetterHealth, our goal is to ensure you get the right care and the right coverage. If you or your healthcare provider disagree with a coverage decision we've made, you have the right to ask us to reconsider. This is called a medical appeal.
Below is a simple guide on how the process works and exactly what you need to submit so we can review your case as quickly as possible.
Who Can File an Appeal?
Both you (the member) and your healthcare provider can initiate an appeal. Often, your doctor's office will handle this on your behalf because they can easily provide the medical records needed to support your case.
What to Submit
To help our clinical team review your appeal thoroughly, we need a complete picture of your situation. Please collect and send us the following four items:
- 1. The Original Claim Form: A copy of the initial claim that was submitted for the service or treatment.
- 2. Explanation of Benefits (EOB) Copies: A copy of the EOB document we sent you that shows the denial. This helps us locate the exact transaction in our system instantly.
- 3. Supporting Medical Documents: This is the most crucial part. Please include any doctor’s notes, clinical records, test results, or medical justifications from your provider that explain why this service or treatment was medically necessary.
- 4. A Cover Letter: A brief note from you or your provider explaining why you are appealing the decision and pointing out any specific details you think our team should closely re-evaluate.
How to Submit Your Appeal
If you choose to file the appeal yourself, the easiest way to get it to us is via email.
1.Gather your documents:Ensure all 4 items are ready.
Make sure you have electronic copies (PDFs or clear photos) of your original claim form, EOB, supporting medical records, and your cover letter.
2.Send us an email:Direct to Member Services.
Email all of your compiled documents directly to members@betterhealthplan.com.
3.Receive confirmation:Within 24-48 business hours.
Our team will review your submission to ensure we have everything we need, log it into our system, and send you a confirmation that your review has begun.
We're Here to Help
If you are missing any of these documents, or if you aren't sure where to find your EOB, please don't hesitate to reach out. You can email us at the address above or call the Member Services number on the back of your ID card. We will gladly walk you through it.