How to appeal a health insurance denial
A denial is often not the final answer. Many denials are overturned when patients respond clearly and on time. Here is how to do it.
1. Read the denial letter closely
Find exactly what was denied (a test, a medicine, a hospital stay) and the reason the insurer gives. Common reasons are "not medically necessary", "out of network", missing paperwork, or needing approval first.
2. Find your deadline
The letter should say how long you have to appeal. For many plans it is 180 days from the date of the letter, but yours may be shorter. Write the date down.
3. Gather proof
Ask your doctor for a letter explaining why you need the care, and collect visit notes, test results, and anything showing treatments you already tried.
4. Write a clear, polite appeal
Include your name, member ID, claim number, what was denied, why you disagree, and what you are asking for. Stick to facts and attach your proof.
5. Send it in a way you can track
Use certified mail, fax with confirmation, or the insurer's online portal. Keep copies of everything and write down every call: date, name, and reference number.
6. If they say no again
You can usually ask for an external review by an independent reviewer. Your denial letter or plan documents explain how.
Want help with yours?
Start my appealThis guide is general information, not legal or medical advice.