If your insurance company has denied you for HIPEC treatment, you should consider appealing if:

• The treatment isn't a covered benefit, but you think the health plan should make an exception for you; or
• You have support from your physician that the treatment is "medically necessary"; or
• The treatment is deemed by the insurance company to be "experimental" or "investigational".

Call the company that issues the denial--armed with a file of your medical and insurance information--including your benefit plan and summary. A customer service representative can't overturn your denial, so ask to speak with a supervisor who has that authority.

Every managed care organization is required by law to have an appeals process.

Although an appeal process isn't perfect, it's much less of a financial and emotional burden than litigation. And your contract with the health plan may prohibit you from filing a lawsuit before filing an appeal.

When formally appealing:

• First, read the appeal process guideline in your policy. Familiarize yourself with timeline requirements;
• Put your complaint in writing, including:
  • Your health problems and treatment history;
  • How you have exhausted all other reasonable alternatives;
  • Physician recommendations;
  • Why you are an ideal candidate;
  • What will happen if treatment is not approved;
  • Support letters from your physicians;
  • Quotes from the benefit plan if it contains helpful language;
  • Medical records that support your position.
• Enlist your doctor's help, as he will be willing to advocate for you;
• Track relevant dates to ensure that your complaint is moving forward expeditiously;
• Be prepared to spend lots of time on the phone;
• Keep a record of all communications--including the date and time of your conversation, the full names and the title of the person with whom you spoke, and a summary of what was discussed.

Your State Department of Insurance (DOI) has a wealth of information, including your rights regarding health insurance, the appeals process, whom to contact regarding an appeal and a general timeline for an appeal.

Click here for a list of State DOI's.

You should also be able to locate your state's DOI in the White Pages "state government" section under "Insurance" or "Regulatory Agencies".

If you have questions regarding the mechanics of the appeals process:

• If you're in a self-insured plan--which means your employer has direct responsibility for medical costs--you should contact someone in your employer's human resources department for more information;
• If you're in a Medicaid managed care plan, you may have special rights in the appeal process and you should contact the State Ombudsman or Medicaid customer service;
• If you're in a commercial plan--which means that the managed care organization has direct responsibility for medical costs--the appeals process is outlined in your policy and follows state laws.

If the cost of denial is enough to offset legal fees, it may be best for you to speak with an attorney who has experience with health care coverage and benefit denials.