Your insurance said no.
That is the first answer, not the last one.
Find what you were denied. Every page says why that particular thing gets refused, what the plan has to hand over when you ask, and prints the whole appeal letter free, ready to copy.
110 denials, grouped by what the plan is actually arguing.
GLP-1 and weight-loss medication
Your prescriber wrote for a GLP-1 and the plan came back with a denial, a prior authorization requirement, or a coverage change that dropped a drug you were already taking.
Biologic and specialty drug
A specialty drug was denied, delayed behind prior authorization, or approved only if you first try something else.
Migraine treatment
A migraine medication was denied, limited to a small number of doses per month, or refused until you try something older first.
Mental health and ADHD
A psychiatric medication, ADHD medication, or mental health service was denied, restricted, or cut off.
Diabetes device and supply
A continuous glucose monitor, pump, or diabetes supply was denied, or coverage stopped for something you were already using.
Imaging and diagnostic scan
An MRI, CT, PET, or other scan was denied, usually before it happened, and usually as not medically necessary.
Surgery and procedure
A planned operation was denied, or a completed one was refused payment after the fact.
Genetic and specialty lab testing
A genetic test, prenatal screen, or specialty lab panel was denied, often arriving as a large bill after the test was already run.
Emergency care
An emergency room visit or ambulance trip was denied, underpaid, or billed at out-of-network rates.
Hospital stay and facility care
An admission, rehabilitation stay, or skilled nursing stay was denied, cut short, or reclassified.
Dental and orthodontic
A crown, root canal, orthodontic treatment, or oral surgery was denied or paid at far less than expected.
Contraception and women's health
Contraception, a menopause treatment, a breast pump, or another women's health service was denied or billed when you expected it at no cost.
Sleep and respiratory
A sleep study, CPAP, inhaler, or other respiratory treatment was denied or cut off.
Prescription drug
A prescription was denied at the pharmacy counter, needed prior authorization, or moved off the formulary.
Physical, occupational and speech therapy
Therapy visits were denied, capped, or stopped partway through a course of treatment.
Denied something not listed here? Paste the denial letter into the free reader and it will tell you which of these families your denial belongs to and what the appeal has to argue.
Not sure which one you got?
Paste the denial letter in. Reading it costs nothing and tells you the reason the plan actually gave, which is often not the reason the letter appears to give.
Read my denial free →What actually happens after a denial
A denial is one reviewer's decision, and the rules that follow it are federal. Most people stop at the first stage below, which is the stage the insurer decides. The stage after that is decided by someone else entirely.
| Stage | Your deadline | Who decides |
|---|---|---|
| Internal appeal | At least 180 days from the denial notice | The plan, but a reviewer who was not part of the first decision |
| Expedited appeal | Decision due in about 72 hours, if you ask for it | The plan, on an urgent track |
| External review | Generally 4 months after the final internal denial, decided in about 45 days | An independent organisation. Its decision binds the plan |
Sources: 29 CFR 2560.503-1(h)(3)(i), the 180-day appeal window; 45 CFR 147.136(d), external review by an independent organisation; HealthCare.gov, how to appeal an insurance company decision. Your plan documents and your denial notice govern your case, and Medicare, Medicaid and some older grandfathered plans run different processes.
Questions people ask after a denial
How long do I have to appeal an insurance denial?
Federal rules give you at least 180 days from the date of the denial notice to file an internal appeal. Your own plan documents and the notice itself govern your case, so read the deadline printed on the letter. Filing early is better than filing late, because a missed deadline ends the appeal regardless of how strong it was.
What happens if the insurance company denies my appeal again?
You can request an independent external review, generally within 4 months of the final internal denial. An outside organisation reviews the claim fresh rather than checking the insurer's work, usually decides within about 45 days, and its decision binds the plan. That last part is the reason external review matters: the insurer does not get to overrule it.
Does an insurance company have to tell me why they denied my claim?
Yes. You are entitled to the specific reason for the denial, the plan provision or clinical criteria it relied on, and copies of the documents and internal rules used to decide your claim, in writing and free of charge. Asking for these in the appeal is worth doing even when you think you know the reason, because the written criteria often name a requirement the denial letter never mentioned.
Can I get a faster decision if waiting would hurt me?
Yes. If a delay would seriously jeopardise your health or your ability to regain maximum function, you can request an expedited appeal, on which a decision is generally due within 72 hours. You have to ask for it. The appeal letter on every page here includes that request.
Do I need a lawyer to appeal a denial?
No. The internal appeal and the external review are both processes you file yourself, in writing, with no lawyer and no filing fee. Most denials that get overturned are overturned on paperwork rather than argument, meaning the plan wanted a document or a diagnosis code that was never in the file.
Is the appeal letter on these pages really free?
Yes. Every denial page here prints a complete appeal letter you can copy or download at no cost, with no account. What we charge for is the version written against the specific reason printed on your own denial notice, with your codes, dates and amounts in it.