If you have an employer-sponsored group plan, you will need to complete two stages of internal appeals.[3] During the first stage, you or your provider should call your health insurer’s medical director or the physician responsible for denying your claim.[4] You may also have to complete all the steps listed above in section I. Your insurer can provide you with clarification.

During the stage-two appeal, you or your provider can appeal the denial to a panel of physicians or other health care professionals selected by your health insurer.[5]  The providers on the panel must not have been involved in the original denial of your claim and must have access to practitioners who are trained in or who specialize in the condition for which you are seeking treatment.[6] You should contact your insurer for instructions on how to request a stage-two appeal.