If you need help understanding why your claim was denied, start by calling your insurance plan (the number should be on the card). Instructions on how to file an appeal should have been included with the denial notice, but ask for clarification if needed.

You have the right to two types of appeals. For detailed information about each, visit these page: Internal Appeals, External Appeals.

Contact your state’s Department of Insurance and/or Insurance Commissioner’s office. All states offer assistance with health insurance appeals, usually through ombudsmen, who can sometimes contact your insurance company on your behalf. 

If you receive your insurance through an employer, ask the Human Resources (HR) department for assistance and support. If it is a self-funded plan, your employer can be especially helpful and influential.

Additional coverage protections may be available to you if you fall under one of the following circumstances:

• If you have an insurance policy based in North Carolina, Virginia, or Maryland these states have enacted lymphedema treatment mandates requiring most private plans sold in those states to cover lymphedema treatment compression supplies. Additionally, California and Louisiana have passed laws that improved coverage for compression supplies. Click on the name of each state for further details.

•  If you are a woman with breast cancer-related lymphedema you may have additional rights and coverage afforded to you under the Women’s Health and Cancer Right Act.

• If you have Primary Lymphedema, and particularly if you are a parent of a child who was born with lymphedema, most states have laws requiring private insurance policies to cover treatments for congenital anomalies, and this includes congenital primary lymphedema. A list of these state laws has been compiled by another organization that works in the area of congenital anomalies.