What does it mean to "appeal" a health insurance decision?

To "appeal" a health insurance decision specifically refers to the process of requesting a review of a denied claim or coverage determination. When a claim for services or a decision about what is covered is denied, an individual has the right to challenge that decision through an appeal. This process allows the insurer to review the details of the case, evaluate the evidence, and potentially overturn the decision to refuse payment or coverage.

This is a critical component of health insurance processes, ensuring that individuals have recourse if they believe a claim has been wrongly denied or if they disagree with a coverage determination. It empowers policyholders by providing them an avenue to seek justice and maintain their rights in accessing necessary health services.

In contrast, the other options reflect different actions unrelated to the appeal process: filing a new application pertains to starting coverage rather than contesting a decision, changing a healthcare provider involves selecting a different doctor or facility without addressing a denial, and canceling a health insurance policy is about terminating coverage altogether rather than challenging a specific decision.