How do I appeal insurance denial?


Editorial team Published on

You can appeal a health insurance denial by requesting an internal review through your insurer's formal process within 180 days of the notice, using guidance from HealthCare.gov.

🔎 1. Understand the Denial

  • Read the Explanation of Benefits (EOB) or denial letter.
  • Identify the exact reason (e.g., not medically necessary, coding error, prior authorization missing).
  • Call your insurer to request written details and confirm the exact appeal deadline.

🗓 2. File an Internal Appeal

  • Submit a formal written request to your insurance company asking them to re-evaluate the decision.
  • Include a strong appeal letter detailing why the service is necessary.
  • Attach supporting documents like medical records, lab results, and a letter of medical necessity from your doctor.
  • Ask for an expedited appeal if your health is in urgent or life-threatening danger.

📊 3. Request an External Review

  • Wait for the insurer's final internal denial decision.
  • Apply for an independent external review through a neutral third party if the internal appeal fails.
  • Note that external decisions are legally binding on the insurance company if the denial is overturned.