Guides / Insurance claim denials

Insurance claim denied? How to appeal in writing

Denials happen for fixable reasons all the time: a missing form, a coding mistake, or a reviewer who didn't see the right document. A written appeal that answers the stated reason is your best shot at getting it reversed.

1. Get the denial in writing

Ask for the denial letter or explanation of benefits if you don't have it. It should say why the claim was denied, which part of the policy they relied on, and how and by when you can appeal. Appeal deadlines are real, so note the date right away.

2. Gather the facts

• Your policy or member number and the claim number
• The denial letter and the policy section it cites
• Bills, receipts, photos, repair estimates, or medical records that support the claim
• A letter from your doctor, contractor, or other professional explaining why the item or service was needed
• Notes from calls with the insurer: date, who you spoke with, and what they said

3. What your appeal letter should include

• Your name, contact details, policy number, and claim number
• A clear statement that you are appealing the denial, with the date of the denial
• The reason they gave, and a direct, factual answer to it
• The policy language that supports coverage, if you can find it
• Exactly what you want, such as payment of the claim in full
• A list of the documents you're enclosing and a request for a written decision

Keep copies of everything and send it in a way you can track.

4. If the appeal is denied

Ask whether a second-level appeal is available. For health insurance, you may also have the right to an independent external review; HealthCare.gov explains how appeals and external review work. For any kind of insurance, you can file a complaint with your state's department of insurance, which oversees insurers licensed in your state.