Insurance Claim Denial Appeal Letter
Appeal a health insurance claim denial through internal appeal or external review. Covers ERISA, ACA, and state insurance protections with plan-type-specific routing and deadlines.
Statute of Limitations Warning
Legal deadlines apply to your claim. You lose your right to act if you wait too long. Send notice as soon as possible.
Why this letter works:
- Cites the exact law: Automatically applies the correct state and federal statutes to your situation.
- Sets a firm deadline: Legally compels a response within the required statutory timeframe.
- Creates a paper trail: Designed to serve as Exhibit A if you need to escalate to an agency or court.
Answer a few questions and we'll create your personalized letter.
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Your Action Plan
This is the final formal demand before litigation.
Download your personalized PDF immediately after purchase and send it.
Your letter includes a firm deadline. Do not engage in informal text messages during this time.
If they miss the deadline, you have completed the required out-of-court steps. Hand this complete paper trail to a local attorney for litigation.
Your Situation
Tell us about the insurance denial so we can route your appeal correctly under federal and state law.
This determines which state insurance protections and external review processes apply to your appeal.
Self-funded plans are governed by ERISA (federal law only — state insurance mandates do NOT apply). Fully insured employer plans are subject to ERISA + ACA + state law. Marketplace/individual plans get full ACA + state protections. Check your Summary Plan Description or call HR to find out.
Most denials start with a first internal appeal. ERISA plans must provide at least one level of internal appeal. The ACA requires one internal appeal before external review. If your situation is urgent (ongoing treatment, serious condition), you may request expedited review.