Your health plan said no. You can ask again.
- Free and nonprofit.
- Nothing you type leaves your device.
- Every rule is cited.
Start with what you are holding. See what it means, which rules apply, the dates you cannot miss, and the letters to answer it.
EXAMPLE HEALTH PLAN
Notice of adverse benefit determination
Date of notice:
November 3, 2026
Member: Pat Sample
Claim number: 000-00000
We have denied coverage of: MRI of the left knee, performed October 14, 2026.
Reason: This service is not medically necessary under clinical policy MP-114.
You may appeal this decision within 180 days of receiving this notice by writing to the Appeals Department.
You may request, free of charge, copies of all documents relevant to this decision.
If you disagree after your appeal, you may be able to ask for an independent external review.
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Your deadline counts from here, or from the day you receive the letter. Write the date down today.
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This is what you have to answer. The wording tells you which kind of denial you have.
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Usually at least 180 days for private plans, but Medicare, Medicaid and others differ.
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You can ask for the documents the plan used, free. Do this before you write the appeal.
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If the plan says no again, an independent reviewer can look at it. That has its own deadline.
What are you holding?
Pick the closest one. You can change your mind.
- My care or stay is endingHours, not weeks
Hospital discharge, rehab, nursing home, home health
- A denial letter
Find the reason, the deadline and your rights
- An Explanation of Benefits
See what was paid, refused and what you may owe
- A bill I did not expect
Check before you pay, and ask for a hold
- A pharmacy said no
Drug not covered, step therapy, quantity limits
- A prior authorization was refused or is stuck
Approval refused, delayed, or withdrawn
- My appeal was denied
The next level, and every option left
Need care or a drug right now?
If waiting could seriously harm your health, you can ask for a fast decision. See the urgent routes. In an emergency, call 911.
See what a denial letter looks like
EXAMPLE HEALTH PLAN
Notice of adverse benefit determination
Date of notice:
November 3, 2026
Member: Pat Sample
Claim number: 000-00000
We have denied coverage of: MRI of the left knee, performed October 14, 2026.
Reason: This service is not medically necessary under clinical policy MP-114.
You may appeal this decision within 180 days of receiving this notice by writing to the Appeals Department.
You may request, free of charge, copies of all documents relevant to this decision.
If you disagree after your appeal, you may be able to ask for an independent external review.
-
Your deadline counts from here, or from the day you receive the letter. Write the date down today.
-
This is what you have to answer. The wording tells you which kind of denial you have.
-
Usually at least 180 days for private plans, but Medicare, Medicaid and others differ.
-
You can ask for the documents the plan used, free. Do this before you write the appeal.
-
If the plan says no again, an independent reviewer can look at it. That has its own deadline.
Find my deadline in 10 seconds
Type the date printed on your notice and pick your coverage. We count it the way the deadline calculator does, from rules that are cited.
Choose your coverage and enter the date printed on your notice.
Not sure? Answer four questions.
What you received, your coverage, what was refused and whether care is urgent. You get your path, your general deadline and first steps.
Find help for your state
Every state has a regulator and most have free help. See who regulates which plans, how to get an independent review, and who to call.
The library
Six places to begin, with the pages in the order most people need them.
- guides
- 105
- letters and scripts
- 65
- tools
- 30
Do these in order
- Step 1 of 3
Understand your denial
Work out what was refused, why, which rules apply to you, and by when you must act.
Starts with: Read your denial letter
- Step 2 of 3
Build your case
Collect the file, the records, your doctor's support and the plan's own rules, then write it up.
Starts with: Get your claim file and plan documents
- Step 3 of 3
Appeal
File the appeal, get a fast decision when health is at risk, and take it outside the plan if it says no again.
Starts with: File an internal appeal
Look things up when you need them
- Look it up
Your coverage
The appeal steps, deadlines and regulators for your kind of plan, from employer plans to Medicare and Medicaid.
Starts with: Job-based plans
- Look it up
What was denied
The playbook for your kind of denial: prior authorization, drugs, out-of-network care, mental health, treatments, billing.
Starts with: Treatments, tests and equipment
- Look it up
Bills and help
Keep the bill from getting worse while you appeal, and find a person who can help, often for free.
Starts with: Find free help
The rules depend on your coverage
Two people with the same denial can have different deadlines and different people to call.
Is it worth the effort?
Most people never appeal. In the federal Marketplace data KFF analysed for 2024, insurers denied 19% of in-network claims, and fewer than 1% of denials were appealed. Where appeals are tracked, a meaningful share succeed: in 2024, 80.7% of Medicare Advantage prior authorization denials that were appealed were overturned.
Tools that do the work
- Tool
Deadline calculator
Turn the date on your notice into the dates you and the plan each have to meet, with the rule behind each one.
- Tool
Appeal letter builder
Pick your denial reason and build an appeal letter with an enclosure list and a next-steps sheet.
- Tool
Find help near you
Pick your state and coverage and see the regulator, the free consumer program and the Medicare counselors for you.