Appeal: ending of ongoing treatment
Asks your plan to keep covering treatment it already approved while you appeal a decision to reduce or end it, and to decide before the benefit stops.
- Private: nothing leaves this tab
- A template, not legal advice
This one is for a specific kind of coverage
It is written for the coverage tagged above. If you have a different kind (for example Medicare or Medicaid instead of a job-based or individual plan), it may cite the wrong rules. Check what kind of coverage you have and use the letter written for it.
When to use this, and what it is not
When to use this. This letter is for private job-based and individual plans (including Marketplace plans). If you have Medicare and a hospital stay, or skilled nursing facility, rehabilitation or home health care, is ending, use the phone script (“Phone script: ask Medicare for a fast appeal when care is ending”) instead. If you have a Medicaid health plan that is cutting or ending your services, use the letter "Appeal my Medicaid plan's cut and keep my services going". Use this when your plan approved a course of treatment and has now told you it will reduce or end it. Send it as soon as you get the notice, before the stop date. Plans that are not grandfathered must continue coverage while the appeal is pending on these terms.
This is a template, not legal advice. Read it, change anything that is not true for you, and send it only when you are satisfied. Your notice and your plan document control.
Fill in the letter
Your letter
[Your name] [Your address]
13 November 2026
[Name and address of the plan's appeals department]
Re: Appeal: ending of ongoing treatment Plan: [Name of the health plan] Member ID: [Member ID] Claim or reference number: [Claim or reference number]
To the reviewer:
I am appealing the notice dated [Date on the denial notice] on claim [Claim or reference number] under [Name of the health plan], member ID [Member ID], which says the plan will reduce or end coverage of [The care or drug that was denied] from [Doctor, hospital or pharmacy] on [The date the plan says coverage will be reduced or ended]. The plan had approved: [The care the plan approved] I ask you to reverse that decision, to keep covering the care as approved, and to confirm in writing, before [The date the plan says coverage will be reduced or ended], that coverage will continue while this appeal is decided.
The plan gave this reason: [The reason the plan gave]
My treating doctor, [Your treating doctor's name and specialty], recommends continuing because: [What your treating doctor says about continuing] My condition and how the care is helping: [Your condition and how the care is helping]
Cutting short a course of treatment the plan has approved is a denial. Under the federal claims and appeals rules, including Title 29 of the Code of Federal Regulations (CFR), sections 2560.503-1 and 2590.715-2719 (for individual coverage, 45 CFR 147.136), the plan must give notice far enough ahead for me to appeal and get a decision before the benefit is reduced or ended, and plans that are not grandfathered must continue coverage while the appeal is pending on these terms. If the plan will not continue coverage, I ask it to tell me the same day, in writing, and to say which rule it relies on.
I ask that someone who was not involved in the first decision, and who is not that person's subordinate, decide this appeal and give no deference to the first decision. If the decision rests on a medical judgment, I also ask that you consult a health care professional with training and experience in the field of my condition who was not consulted on the first decision. Please consider every record and comment I send, including anything that was not before the first reviewer.
Please send me your decision in writing before [The date the plan says coverage will be reduced or ended]. If you uphold the denial, I will ask for external review by an independent organization, and if the care is urgent I will ask for it to be expedited, and I may complain to the agency that regulates my plan.
Enclosures: 1. Copy of the notice that the care will end 2. Copy of the original approval 3. Letter from my treating doctor 4. Recent treatment notes
Sincerely, [Your name]
Before you send it
Send it to the appeals address printed on your denial notice, by a method that proves delivery, such as certified mail with a return receipt or the plan's online portal with a saved confirmation page. Because the care may stop on a set date, also call the number on the notice and ask for an expedited appeal. Keep a complete copy of the letter and everything you enclose, and write down the date and the method you used.
What to enclose
- Copy of the notice that the care will end
- Copy of the original approval
- Letter from my treating doctor
- Recent treatment notes
What happens next
- Send this now, and call the plan to confirm it arrived. Ask the plan, in writing, to confirm that coverage will continue while the appeal is decided. The plan should decide before the benefit is reduced or ended. Check the date on your notice, which controls.
- If waiting could seriously harm your health, ask for an expedited appeal, which must be decided within 72 hours. An urgent request to extend approved treatment must be decided within 24 hours if you make it at least 24 hours before the approved treatment runs out.
- After a final internal denial about a continued stay, availability of care or an admission, expedited external review is available while you have not been discharged. For other decisions, most job-based and individual plans must give you at least four months to ask for external review. Check the date on your notice, which controls.
- You can also complain to the agency that oversees your plan. A complaint does not stop your appeal deadline, so file the appeal first.
- If you are writing for someone else, tick "I am writing for someone else". The plan may require its own authorization form. See the letter "Name someone to act for you".
The rule behind this
Sources
Denial reasons this answers
- Denial reason
Care is ending
Hospital, rehab, nursing home or home health care ending? Medicare: call the reviewer on your notice by noon the day after you get it, or 1-800-MEDICARE (1-800-633-4227). Medicaid or job-based plan: see What to send.