Arizona exceptions and appeals

Arizona law requires health insurers, health maintenance organizations (HMOs), dental plans, prepaid dental plans and vision plans to provide their insured members with a way to appeal denied claims or denied services.

• Denied claim – The insurer denies payment for a submitted claim on care you’ve already received.
• Denied service – The plan will not authorize a covered service (such as a referral to a specialist), or the plan will not preauthorize a treatment or procedure that you or your doctor believe is medically necessary and covered by your benefit plan.

If you have an individual plan or a fully insured group plan (through your employer) for medical, dental, or vision benefits, you can appeal our decision for denied claims or services.

For a detailed explanation of the appeal process, review the Health Care Appeals Information Packet available in these links:

Arizona Medical Appeals Packet – English version

Arizona Medical Appeals Packet – Spanish version

Arizona Dental and Vision Appeals Packet – English version

Arizona Dental and Vision Appeals Packet – Spanish version

You can file an appeal through the Exceptions and appeals – Insurance through an employer page. Select the appeal you’d like to make and follow the instructions on that page.