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Marketplace America.org Health Insurance

Appeal

What is an Appeal?

A request to your health insurer or the Health Insurance Marketplace® to reconsider a decision that denies a benefit or payment.

  • If you do not agree with a decision made by the Marketplace, you can lodge an objection. Small businesses can also appeal decisions made by the Small Business Health Options Program (SHOP).
  • If your health insurer refuses to pay a claim or terminates your coverage, you have the right to appeal the decision and have it reviewed by a third party.
References

“Glossary.” HealthCare.gov, www.healthcare.gov/glossary/.

CMS.gov. Glossary of Health Coverage and Medical Terms. CMS.gov, 2020. https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/Uniform-Glossary-01-2020.pdf. PDF file.

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