Insurance denials
Appeal the insurance denial.
Insurance companies deny first and hope you go away. About half of appeals succeed. Here is the letter that starts the appeal.
Claim details
Your appeal letter
Copy the letter below. Print on letterhead if available. Send via certified mail with return receipt requested.
Documents to attach
- Copy of denial letter (EOB)
- Complete medical records for date of service
- Letter of medical necessity from attending physician
- Peer-reviewed study citations (if experimental denial)
- FDA approval documentation (if experimental denial)
- Professional society clinical guidelines
- Photos of completed certified mail receipt
Most plans: 180 days from denial date to file internal appeal. If internal appeal is denied, you typically have 4 months to file external review. State insurance commissioners regulate individual plans; Department of Labor regulates ERISA employer plans. Deadlines are strict and missing them forfeits your right to appeal.
Disclaimer: Not medical or legal advice. Appeal deadlines are strict — check your plan's Summary of Benefits for exact dates. State insurance commissioners regulate most individual plans; DOL regulates ERISA employer plans. Consult a patient advocate or attorney for complex cases.