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How to Appeal a Health Insurance Decision

Occasionally, your health insurance claim may be denied. Paperwork and persistence are crucial to reversing your carrier’s decision.

Instructions

  • Step 1: Enlist doctor’s aid Enlist your doctor’s assistance with correct coding information, proper documentation, and medical records.
  • Step 2: Write appeal letter Write your appeal letter. Be sure to include the date, claim number, date of service, policy number, reason for denial, why you are writing, and what you are requesting.
  • TIP: Sample medical appeal letters are available online.
  • Step 3: Include paperwork Include supporting paperwork with your appeal letter such as letters of medical necessity from your physician and medical records.
  • Step 4: Identify address Identify the address where you will need to send your appeal. It may be different than the claim submission address.
  • Step 5: Send certified mail Send via certified mail. The return receipt will ensure that your appeal is received.
  • FACT: Did you know? The first U.S. health insurance plans began during the Civil War and offered coverage of rail- or steamboat-related travel accidents.

You Will Need

  • Help from your doctor
  • Medical paperwork
  • Persistance
  • A computer with internet access (optional)

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