How to appeal a health insurance denial
Insurers deny claims every day for reasons that don't hold up. Most people never appeal, but you have the right to, and an outside reviewer can overrule your plan.
Updated October 11, 2026 · General information, not legal advice.
Step by step
- 1Read the denial letterFind the exact reason, the claim number and the appeal deadline. Most plans give you 180 days from the denial to file an internal appeal.
- 2Ask for your claim fileYou can request, free of charge, the documents and criteria the plan used. It shows you what to answer.
- 3Get your doctor's supportA letter or notes from your doctor explaining why the care is medically necessary is often the strongest part of an appeal.
- 4Write the appealName the service, date and claim number, answer the reason for the denial point by point, and ask for a reviewer in the same specialty.
- 5Track their deadlinePlans generally must decide within 30 days for care you haven't had yet and 60 days for care you've already had, or 72 hours if it's urgent.
- 6Ask for an external reviewIf the final internal appeal is denied, you can usually request an independent external review, generally within 4 months. The plan must follow the reviewer's decision.
Who to complain to
For most individual and small-employer plans, contact your state insurance department. Large employer plans that pay claims themselves are overseen by the U.S. Department of Labor (EBSA). For surprise out-of-network bills, contact the No Surprises Help Desk at 1-800-985-3059.
Questions
How long do I have to appeal a denied claim?
Usually 180 days from the denial notice for an internal appeal under ACA rules, though check your letter. External review requests are generally due within 4 months of the final internal denial.
Do insurance appeals work?
Often, especially with your doctor's notes. Many denials are for missing paperwork or coding, which an appeal can fix.
What if it's urgent?
Ask for an expedited (urgent) appeal. Plans generally must decide within 72 hours, and you can request an expedited external review at the same time.