Ask for your claim file
A written request for everything the plan used or created when it decided your claim, sent before you appeal. It asks for the file free of charge and says clearly that it is not an appeal.
- 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. Use this before you write your appeal if you have a job-based plan or a Marketplace or individual plan. It is a records request, not an appeal, so it does not pause your appeal deadline. For Medicare or Medicaid, follow your program's own steps instead.
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: Ask for your claim file Plan: [Name of the health plan] Member ID: [Member ID] Claim or reference number: [Claim or reference number]
To whom it may concern:
I am a member of [Name of the health plan], member ID [Member ID]. On [Date on the denial notice] the plan denied my claim [Claim or reference number] for [The care or drug that was denied] from [Doctor, hospital or pharmacy], date of service [Date of the care].
I am asking for my claim file. This is a request for records. It is not an appeal, and I am not giving up my right to appeal.
Please send me, promptly and free of charge, copies of all documents, records and other information relevant to this claim. Under the federal claims rule, that includes anything the plan relied on; anything submitted, considered or generated in deciding the claim, even if the plan did not rely on it; anything showing the plan applied its rules consistently; and, for group health plans, any statement of plan policy or guidance about the denied treatment for my diagnosis. Please include reviewer notes, case management notes, and any correspondence about this claim. [Anything else you want included]
I also make this request as a request for my own claims and case management records under the federal health privacy rule, the Health Insurance Portability and Accountability Act (HIPAA). Please reply in writing within 30 days of the date of this letter. If you need more time, please tell me why in writing and say when I will receive the file.
Please send the file [How you want to receive the file]. I want proof of delivery, so please confirm in writing the date you received this request and the date you send the file.
Enclosures: 1. Copy of the denial letter or Explanation of Benefits 2. Copy of your member card (front and back)
Sincerely, [Your name]
Before you send it
Send it to the address the plan gives for appeals or member records. Look on your denial notice, your member card or the plan's website. If you cannot find one, call the member services number on your card, ask where written requests go, and write down the date, the person's name and any reference number. To prove it arrived, use certified mail with a return receipt, or fax it and keep the confirmation page, or send it through the plan's online portal and take a screenshot that shows the date. Keep a copy of the letter.
What to enclose
- Copy of the denial letter or Explanation of Benefits
- Copy of your member card (front and back)
What happens next
- You: send the letter the day you finish it, and keep a copy plus the proof of delivery (certified mail receipt, fax confirmation page or portal screenshot).
- You: write day 30 on your calendar. The health privacy rule gives a health plan 30 days to act on a request for your records, with one extension of up to 30 more days if the plan explains the delay in writing. That 30-day rule applies to the plan. The separate 30-day penalty in the Employee Retirement Income Security Act (ERISA) is for plan documents, not the claim file, and some sources say many courts have not applied it to claim files (we have not confirmed that), so do not count on it.
- You: do not wait for the file if your appeal deadline is close. For most job-based and individual plans you have at least 180 days after you receive the denial notice to appeal, and your plan may allow more. A grandfathered individual policy may give less. Check the date on your notice, which controls. File the appeal and say in it that you have asked for the claim file.
- You: when the file arrives, compare it with your denial letter. If pieces are missing, send a short follow-up listing what is missing. For a job-based plan you can also ask the United States Department of Labor, Employee Benefits Security Administration, for help at 1-866-444-3272.