Your Coverage & Care
Your Coverage & Care
Appeal Process Resources

Appeal Process Resources

These tools, resources and contact information will help you understand how a health plan works, manage the appeal process and get assistance with your appeals or health care expenses. You’ll also learn about the Arthritis Foundation’s advocacy efforts for insurance and medication coverage reform.

Sample Appeal Letters

Use these templates to develop your own communication or as examples for your healthcare providers to use.

Sample Summary of Benefits and Coverage (PDF)

Use this example as a guide to understand the benefits, coverage and out-of-pocket expenses for a health plan.

Sample Explanation of Benefits (PDF)

Use this example as a guide to understand your explanation of benefits.

Communication Log (PDF)

Use this resource to help keep track of your communication as you manage your appeals.

Medicaid Appeals Process (PDF)

A resource for understanding different types of Medicare programs and the related appeal process and where to get help if you have questions.

TRICARE Appeals Process (PDF)

A resource for understanding the medical claim appeal process if you are active or retired military as well as contact information for various TRICARE offices.

Medicaid Appeal Example (PDF)

This document provides sample step-by-step instructions for navigating a Medicaid appeal process.

Medicare National Coverage Determinations Manual 2016 (PDF)

This document provides examples of specific medical items, services, treatment procedures, or technologies that Medicare covers. 

Find Your State Department of Insurance

Get contact information for your state department of insurance. 

Financial Assistance Programs

The Arthritis Foundation has gathered important information on patient assistance programs provided by the government, non-profit and corporate sources.

Consumer Assistance Programs

Many states offer help to consumers with health insurance problems.

Help the Arthritis Foundation Fight for Insurance and Drug Coverage Reform

People with arthritis face unique barriers to care: high costs of treatment, difficulty accessing medications, scarcity of specialists and coinsurance that limits access to treatment. Join the Arthritis Foundation’s advocacy efforts.

arthritis foundation prescription for access
arthritis foundation prescription for access