An appeal is an official request for reconsideration of a previous denial issued by Seven Corners, Inc.
If your claim has been denied, and you’ve received a letter from us explaining why it was denied, you have the option to appeal our decision. You must submit a claim appeal in writing with supporting documentation.
Your claim was processed by analysts who are trained to interpret policy language, and simply disagreeing with our decision is not sufficient to change the denial. You can view the details for the claim denial in our letter along with the reason the claim did not meet the policy requirements.
The following information is provided as a general resource for customers and providers to help you appeal a claim denial.
How to Appeal a Claim Decision
Step 1: Contact Us
Call the Customer Service number on your customer ID card. If your concern regarding the denied claim is not resolved through a discussion with our Customer Service Advocate, you may submit a written appeal.
Step 2: Submit a Written Appeal
Seven Corners, Inc. must receive your written appeal within 12 months of the date you were notified of the denial of benefits or services. It's important for you to explain why you believe your claim should be paid and provide documents and information to support your appeal. Address the letter to Attn: Appeals and submit it as follows:
- Download our sample letter form to your desktop, complete it with your information, and save the letter.
- The letter asks for the information shown in red because we need these items to identify your claim:
- Primary Insured Name
- Name of Person whose claim was denied
- Certificate Number (you can find this on your ID card and the claim denial letter)
- Claim Number (you can find this on the claim denial letter)
- Contact Information
- In your letter include the reason you believe an error was made and why you believe your claim should be paid.
- Provide supporting documentation. Here are some examples:
|If your claim denial letter states the claim was denied due to:
||We recommend you submit:
|A pre-existing condition
||Medical records indicating the onset date of the condition
| Medical records submitted contained an error
||Corrected medical records along with a written explanation from the provider for the error
|A specific exclusion in the policy
||Documentation which proves the exclusion does not apply
- Important to Note: If you received a letter stating your claim was closed due to lack of supporting documentation, you DO NOT need to file an appeal. Instead, send the requested information to firstname.lastname@example.org and your claim will be re-opened for consideration.
Seven Corners, Inc.
303 Congressional Boulevard
Carmel, IN 46032 USA
Note: we have a limit of 25MB for attachments. If you have a larger attachment, please send it separately.
Step 3: Appeal Decisions
Appeal decisions are addressed by Seven Corners, Inc. within 30 days of receipt. We will send appeal decisions to you in writing with a detailed explanation about the decision, as well as any documentation to support the decision.
Providers please note:
- Before sending an appeal, please verify the reason for denial. Sending the appropriate supporting documentation ensures a more efficient response.
- UnitedHealthcare Global participating providers should refer to their participating provider agreement and applicable provider manual for information on specific provider claim review or appeal rights.