Ask for a denial in writing
A written request for a proper denial notice when the plan has only told you by phone that it will not approve or pay. It lists what the notice must contain so you know your reason and your appeal rights.
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- 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 when someone at the plan or a provider told you by phone or in person that care is denied and you have nothing in writing. It works for job-based plans and for Marketplace or individual plans. If the denial was about urgent care and was given orally, the written notice should follow within 3 days.
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 a denial in writing Plan: [Name of the health plan] Member ID: [Member ID] Claim or reference number: [Claim or reference number]
To whom it may concern:
On [The date you were told], [Who told you, and how] told me that [Name of the health plan] will not approve or pay for [The care or drug that was denied]. My member ID is [Member ID]. I have not received a written denial notice.
Please send me a written or electronic denial notice. The federal claims rule requires a denial notice to be written or electronic, "calculated to be understood by the claimant," and to state:
1. The specific reason or reasons for the denial. 2. The specific plan provisions relied on. 3. Any additional material needed to complete the claim, and why it is needed. 4. The plan's review procedures and time limits, including, for an employer plan covered by the Employee Retirement Income Security Act (ERISA), the right to sue under ERISA section 502(a).
If my plan is not grandfathered, the notice must also identify the claim (date of service, provider and amount), state that the diagnosis and treatment codes and their meanings are available on request, give the denial code and its meaning, describe the standard used to deny the claim, explain how to start an internal appeal and an external review, and give contact details for any state consumer assistance program or ombudsman.
If the denial rests on medical necessity, experimental treatment or a similar limit, please include the clinical explanation or tell me it is available free on request, and send it. If an internal rule, guideline or protocol was relied on, please include it or tell me it is available free on request, and send it.
I understand that the time to appeal is counted from when I receive the denial notice. I am not waiving or delaying any right to appeal by sending this request. Please send the notice promptly and confirm in writing the date you received this request.
Enclosures: 1. Any paperwork you received, such as an Explanation of Benefits or a pre-approval confirmation number
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
- Any paperwork you received, such as an Explanation of Benefits or a pre-approval confirmation number
What happens next
- You: send the letter and keep the proof of delivery. Also write down the date and time of the call, the name of the person who told you, and any reference number.
- Plan: the rule requires a written or electronic notice. This site's sources do not give a separate deadline for a request like this one, except that an urgent-care denial given orally must be followed by written notice within 3 days. The plan's decision deadlines (72 hours if urgent, 15 days before care, 30 days after care) also limit how long a notice should take, so say in the letter how long ago you were told. Ask for a date in the call or the letter.
- You: do not wait for the notice if you can avoid it. 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. Ask the plan on the phone how to file an appeal now, and write the answer down.
- You: when the notice arrives, check that it has every item listed in the letter. If something is missing, send a short follow-up naming what is missing, then use the appeal letter that fits the reason.