Health Insurance

31 My claim was denied. Now what? Your health insurance policy tells you how to appeal if your plan denies your claim or pays less than you think it should. You have a right: • To receive an explanation of your plan’s grievance and appeal procedures. • To file a complaint, also called a grievance or appeal, with your plan. • To receive an easy-to-understand written decision on your appeal. • To file a complaint with CDI, Call 1-800-927-4357 or visit www.insurance.ca.gov . Independent Medical Reviews (IMR) In an IMR, independent medical professionals review a medical decision made by your insurance company. You can ask for an IMR if your health plan: • Denies, changes, or delays a service or treatment, based on a decision that it is not medically necessary. • Will not cover an experimental or investigational treatment for a serious medical condition. • Will not pay for emergency or urgent medical services that you have already received. For more information about IMR: • Go to www.insurance.ca.gov • Call CDI at 1-800-927-4357