Insurance Basics
How to Appeal a Denied Claim
Practical steps when a plan denies coverage you believe should be paid.
Start with the denial reason
Read the Explanation of Benefits and denial letter. Note whether the issue is medical necessity, coding, out-of-network, or prior authorization.
Ask your clinician for supporting notes. Many denials reverse when the right documentation arrives.
Internal then external review
File the plan's internal appeal on time. If denied again, you may have external review rights under federal or state rules.
Keep a paper trail: dates, reference numbers, and copies of everything submitted.
Next step
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Questions
Frequently asked questions
How long do I have to appeal?
Deadlines vary by plan — often 180 days for internal appeals. Check your denial letter.
Can an agent appeal for me?
Sometimes; you can also authorize your clinician's office. You remain responsible for deadlines.
Sources
- HealthCare.gov — the official ACA Health Insurance Marketplace · reviewed 2026-01-15
- KFF (Kaiser Family Foundation) — health policy research · reviewed 2026-01-15
- OLYRON HealthMatch editorial methodology — how we source and rate options · reviewed 2026-01-15