How do you appeal when your health insurance doesn't want to cover a needed procedure?

Is it necessary to hire an attorney? Please help
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No, its not necessary to hire an attorney. (At least, not for any of the early levels of appeal.) Your certificate of coverage/policy document should specify appeal procedures - if not, you can get the appeals address from your insurance company. I don't know what state you're in, but generally the state Department of Insurance has guidelines as to appeal processes. You need to exhaust all levels of appeal with your insurer before the Dept of Insurance would be able to investigate on your behalf. One question - is the service being denied because the insurer says that its not medically necessary? Or is the service being denied because its something that's an exclusion on your policy? If the service is spelled out as an exclusion, then there's not much you can do about it. Your policy is a contract, and the insurance company isn't obligated to cover anything that's excluded from your contract. However, if its being denied stating that its not medically necessary, then your appeals need to demonstrate why the procedure IS medically necessary. Any and all documentation you have should be sent - chart notes from your physician or other health providers, etc. - send this documentation along with your letter of appeal.
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