You are here: Home Insurance Health Insurance ... Glossary of ... Adverse Determination
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Glossary of Health Insurance Terms To Know

Adverse Determination

Next » « Previous


An Adverse Determination is a decision by an insurer not to pay for a particular drug or treatment. There can be a variety of reasons for the decision. 

Patients have the right to appeal an Adverse Determination by following the insurer's appeal process.  If that doesn't work, patients generally have a right to appeal to an independent reviewer who is not connected with the insurer.

Appealing an Adverse Determination inside the insurance company is known as appealing internally. Appealing outside the insurance company is known as appealing externally.

Please share how this information is useful to you. 0 Comments


Post a Comment Have something to add to this topic? Contact Us.

Characters remaining:

  • Allowed markup: <a> <i> <b> <em> <u> <s> <strong> <code> <pre> <p>
    All other tags will be stripped.