How to write an insurance appeal letter

Start with your denial notice

Your plan must explain in writing why it denied the claim or service. Find the notice or the explanation of benefits and note:

• The service, medicine or claim that was denied.
• The reason the plan gave, word for word if you can.
• Your member ID, claim or reference number, and the date of the notice.
• The appeal deadline and where to send your appeal.

Check your deadline

For many plans, you have 180 days from the denial notice to file an internal appeal. If the internal appeal is also denied, you may be able to ask for an external review by an independent reviewer. Your notice lists the exact deadlines for your plan, so go by what it says. If waiting could seriously harm your health, ask for an expedited (urgent) appeal. You can read more on HealthCare.gov.

Gather what supports your request

• A copy of the denial notice.
• Relevant records, test results or notes you already have.
• A letter of support from your treating clinician, if they are willing to write one.
• A short timeline of what you have already tried.

The free symptom timeline can help you organize scattered dates and notes.

Write the letter with the appeal tool

The insurance appeal letter tool asks a few plain questions and builds a formal appeal that names the denial reason and asks for a specialist reviewer. If your plan requires approval before a service, the prior authorization letter tool can help with that request. See all the guided letter tools.

After you send it

Send it the way your notice says, keep a copy of everything, and write down the date you sent it. If you do not hear back by the time your plan says it will decide, call and ask for the status.

Safety comes first

This guide is advocacy education, not medical or legal advice. Do not delay needed care while an appeal is pending; talk with your clinician about options.

For a medical emergency, call 911 or go to the nearest emergency department. For an emotional crisis, call or text 988.