July 28, 2022

Have you ever had coverage for a medication, benefit or medical visit denied by your health plan? While this is frustrating, learn more about what actions you may be able to take on Nova’s latest podcast episode, “I Don’t Want a New Drug.”

Dawn, a training specialist at Nova who also previously held roles in customer service and quality assurance, joins this episode of “Under the Coverage” to share her experience in the appeals process, in response to a question submitted by a listener: “What options do you have when a medication or treatment has been denied by your insurance company? Can you fight the decision? How?” 

“Whenever there is a denial of some sort, you do have the right to appeal or fight the decision,” shares Dawn. “How you would do that is dependent on your plan.”

Our guest talks through where to start if you wish to appeal a denial, which varies not only by your health plan’s guidelines but also based on what’s being denied (e.g., a claim, pre-authorization for a service, prescription). In many cases, members receive a denial letter from their insurer, which should provide further details specific to their case and sometimes even a form to complete to file an appeal.

To learn more about the appeals process and steps you can take if you’ve had coverage denied, tune into our newest podcast.

How to Listen

New episodes are added regularly and are available on SoundCloud, Stitcher, Spotify, Apple Podcasts, Google Podcasts, Amazon Music and TuneIn. You can also listen via digital assistants like Alexa, Google and Cortana. Just ask Alexa to, “play the Under the Coverage podcast on Apple Podcasts” (or wherever you get your podcasts).

Under the Coverage features people who spend their working days focused on health benefits and health care, sharing their insider tips on information they wish every health care consumer knew. Have an idea for a future episode or a question you’d like answered? Find Under the Coverage on Twitter @UndrTheCoverage or email podcast@novahealthcare.com.