What To Do When Your Insurance Denies a Claim
April 2025 · 6 min read
A health insurance denial feels final — but it is not. Under federal law, you have the right to appeal every denial. And the numbers are on your side: studies show that more than half of appeals succeed when patients follow the right process.
Do Not Accept the Denial
Many patients assume a denial is the final word. It is not. Insurance companies deny claims knowing most patients will not appeal. The moment you file an appeal, you dramatically increase your chances of getting covered.
Your Legal Rights
- Right to an explanation — your insurer must tell you why they denied your claim
- Right to an internal appeal — you can ask your insurer to review the decision
- Right to an external review — an independent reviewer can overturn your insurer's decision
- Right to an expedited appeal — for urgent medical situations, you can request a faster review
The 5 Things to Do Immediately
Read the denial letter carefully
Understand the exact reason for denial. This determines your entire appeal strategy.
Check your deadline
Most plans give you 30–180 days to appeal. Missing the deadline forfeits your right.
Call your insurance company
Ask for clarification on the denial reason. Sometimes errors can be corrected with a simple call.
Talk to your doctor
Your doctor can write a letter of medical necessity — one of the most powerful tools in an appeal.
Write and submit your appeal letter
A professional, well-documented appeal letter is your best weapon. Use AppealRx to generate one in 60 seconds.
If Your Appeal is Denied Again
If your internal appeal fails, request an external review. Under the Affordable Care Act, you have the right to have your case reviewed by an independent organization. Their decision is binding — your insurer must comply.
You can also contact your state insurance commissioner or a patient advocate for additional help.
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