Independent Appeals Administration

Unbiased, expert review of medical coverage appeals

Our Independent Appeals Administration team is well-informed about medical, benefit, and state and federal regulatory issues, with a solid track record working with insurance companies and third-party administrators. We research and analyze appeals, provide sound recommendations, and comply with regulations and timelines. Your HR department is assured that we have the expertise to properly manage appeals.

Program features:

  • In-depth knowledge about medical, benefit and regulatory issues
  • Thorough preparation for analysis and recommendations
  • Smooth, seamless transfer of information for review
  • Competitive pricing based on PEPM model
  • Final determination letter to employees, written in your voice
  • Offers suggestions to clarify coverage issues that may be unclear or uncommon

Key benefits:

  • Objective analysis for accurate appeals decisions
  • Human Resources staff support
  • Ensures fair and consistent treatment
  • Clear communication about coverage and benefit decisions
  • Compare coverage guidelines, as needed
  • Compliance with timelines
  • ERISA compliance
  • Medical policy review and clarification
  • Compliance with state and federal regulations
  • Advises if covered benefits are consistent with the industry
  • Keeps up-to-date with new laws
  • Avoid costly mistakes
  • Right checks and balances
  • Seamlessly integrates with all Health Advocate programs