Explanation of Benefits InCalifornia, health plans are supposed to help facilitate theappeals process and inform members in writing how to appeal.(Photo: Shutterstock)

Have you ever stepped up to the pharmacy cash register only tolearn your new prescription will cost you hundreds of dollars —instead of your typical $25 copay — because your insurance doesn'tcover it? Or received a painfully high bill for a medical testbecause your health plan didn't think it was necessary?

Most people have, but only a tiny fraction ever appeal suchdecisions. In 2017, for example, enrollees in federally runAffordable Care Act marketplace plans appealed fewer than one-halfof 1 percent of denied medical claims, according to ananalysis by the Kaiser Family Foundation. (Kaiser Health Newsis an editorially independent program of the foundation.)

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