How to Appeal a Anthem How to Appeal an Out-of-Network Denial
Anthem denied your claim for how to appeal an out-of-network. This guide combines Anthem-specific appeal procedures with the strongest arguments for how to appeal an out-of-network denials.
48% of out-of-network denials are overturned, rising to 72% when the No Surprises Act applies.
Anthem Appeal Details
Send Appeal To
Anthem Appeals — varies by state plan
Deadline
180 days from denial date
Why This Denial May Be Wrong
An out-of-network denial means your insurer is refusing to cover (or is paying less for) a service because the provider was not in their approved network. This often results in surprise bills when patients receive care at an in-network facility but are treated by an out-of-network provider they didn't choose.
The No Surprises Act (effective January 2022) provides significant protections against surprise out-of-network bills, particularly for emergency services and services at in-network facilities.
Your Legal Rights
The No Surprises Act prohibits surprise billing for emergency services, air ambulance services, and services at in-network facilities by out-of-network providers. If you received care at an in-network facility, you generally cannot be balance-billed by out-of-network providers at that facility. State laws may provide additional protections.
How to Appeal: Step by Step
- 1Determine if the No Surprises Act applies to your situation (emergency care or in-network facility).
- 2If it does, cite the No Surprises Act in your appeal and request processing at the in-network rate.
- 3If it doesn't, check your plan's out-of-network benefits and appeal for fair reimbursement.
- 4Document that you had no choice in provider selection (if applicable).
- 5Submit your appeal with supporting documentation.
Anthem's Known Patterns
- ⚠Automated denial systems with limited clinical review
- ⚠Strict prior authorization requirements
- ⚠Known for narrow network restrictions
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FAQ
What is the No Surprises Act?
A federal law effective January 2022 that protects patients from surprise medical bills when they receive emergency care or care at in-network facilities from out-of-network providers.
Can I be balance-billed?
In most emergency situations and at in-network facilities, no. The No Surprises Act prohibits this practice.