You Have the Right to Appeal: Now What? A Step-by-Step Guide

Episode Summary:

In this episode of From the Clinic to the Courtroom: Health Law Unpacked, host Kevin Rosenquist and health law attorney Maria T. Santi, Esq. walk listeners through the complicated and often overwhelming process of appealing a health insurance denial. Whether it’s a time-sensitive treatment or a misunderstood policy exclusion, Maria shares the critical steps patients must take to protect their rights—from reviewing the denial letter to filing a lawsuit if necessary.

You’ll learn:

• What to do immediately after receiving a denial.
• The difference between internal appeals, external reviews, and lawsuits.
• The most common—and costly—mistakes patients make.
• How to gather documentation that makes a case stronger.
• How to feel empowered when taking on a large insurance company.

If you’ve ever been denied coverage or know someone navigating the appeals process, this episode is a must-listen.

 

Timestamps:

00:00 – Welcome and episode introduction 00:44 – First steps after receiving an insurance denial 02:00 – Gathering documentation and working with doctors and attorneys 03:15 – How to properly structure an appeal package 04:52 – Timelines: When insurance companies must respond 05:19 – Internal vs. external appeals explained 07:22 – When to file a lawsuit 08:49 – Jury trials, costs, and who pays attorney fees 10:19 – Missing deadlines: Are appeals still possible? 11:55 – Common patient mistakes during appeals 13:43 – How Maria empowers clients through the process 15:01 – Episode close and how to connect with Maria's team

 

About the Show:

From the Clinic to the Courtroom: Health Law Unpacked is hosted by Maria T. Santi, Esq., founder and managing partner of the Health and Medicine Law Firm. Each episode demystifies a crucial aspect of health law, offering patients and providers alike the legal clarity and tools they need to navigate the healthcare system. Whether it's insurance denials, patient rights, or provider compliance, Maria’s mission is to educate and empower.

 

Learn more at healthandmedicinelawfirm.com