Claim Appeals

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. Claim appeals must be submitted in writing with supporting documentation. Simply disagreeing with our decision is not sufficient to change the denial.

Your claim was processed by analysts who are trained at interpreting policy language. We provide all claim denials in writing along with the the reason the claim did not meet the policy requirements.

The following information is provided as a general resource for members and providers to help you appeal your claim denial.

How to Appeal a Claim Decision

Step 1: Contact Us

Call the Customer Service number on your member 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 of notification of the denial of benefits or services. Sending the appropriate reasoning and supporting documents in your appeal is critical to ensuring expedient handling. 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 will ask for the the information shown in red, 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; such as follows:
    If your claim denial letter states the claim was denied due to: We recommend you submit:
    A pre-existing condition Medical records indicating 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 claims@sevencorners.com and your claim will be re-opened for consideration.

Submission Methods:

Mail
Seven Corners, Inc.
Attn: Appeals
303 Congressional Boulevard
Carmel, IN 46032 USA

Fax (+01)317-575-2256

Email appeals@sevencorners.com

Note: we have a limit of 10MB 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.

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