Appeals Process

An appeal is when you, the member, disagrees with a determination of your processed medical expense and you have supporting documentation.

Most of the time, your concerns will be cleared up by calling our member experience team to discuss how the expense was processed and why.

However, if after discussing the processed expense(s) you still feel the additional information you have received (such as additional medical records or an addendum to the medical records) should be reviewed by our medical staff due to the possibility of a different determination, you may file an appeal.

An important note: if you file an appeal without additional supporting documentation, this will be designated an invalid appeal and not reviewed. Also please be aware that members are unable to appeal any Guidelines (elements that are a built part of the programs, such as the Maternity 6-month waiting period, preexisting condition limitation periods, etc). These are core elements of the program that help in establishing consistency amongst the entire membership.

How to file an appeal:

Email us at appeals@netwell.com with the following:

1. DOS/Provider/Billed Amount

2. Denial Reason

3.Please attach the additional documentation with a summary on what the documents are and why you feel this would need reviewed by the medical staff to be possibly overturned.

 

Please allow us up to 30 days after the email is received for the outcome of the appeal to be returned.

For additional help or information, please reach out to us.

Contact us at: 866-NETWELL (638-9355)

Our business hours are Monday through Friday, 8:00 AM to 8:00 PM EST.