Appeal letter builder

Pick your denial reason and build an appeal letter with an enclosure list and a next-steps sheet.

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General information, not legal advice

What it asks, and what it is not

What it asks. The denial reason, the facts of your claim, and what you want the plan to do.

Everything you type stays in this browser tab. Nothing is sent anywhere, and no account is needed.

What it is not. It assembles a letter from reviewed wording and your own facts. It leaves blanks rather than inventing medical details, and it does not send anything.

What was the reason for the denial?

Find your reason

The most common reasons

Or, if this is you

More reasons11

Not sure which one fits? Match the wording on your letter to a reason.

Choose one above and the letter appears here.

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Open the letter you need

Each letter page shows the full text with highlighted blanks. Print it and write in the blanks by hand.

Appeal: approved, then denied
Asks your plan to pay a claim for care it approved in advance, and to explain what changed and which plan provision lets it deny payment after approval.
Appeal: coding error and reprocessing
Asks your plan to reprocess a claim that was denied because of a billing or coding mistake, after your provider has corrected and resubmitted it.
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.
Appeal: emergency care denied
Asks your plan to cover an emergency visit using the prudent layperson standard, judged on your symptoms at the time rather than the final diagnosis.
Appeal: equipment or supplies
Asks your plan to cover medical equipment or supplies it denied, using your plan's own wording, your prescriber's order and how the equipment is used in your daily life.
Request an expedited appeal
Asks your plan to decide an appeal as an urgent claim, within 72 hours, because waiting could seriously harm your health, and to contact your doctor.
Appeal: experimental or investigational
Asks your plan to reverse an experimental or investigational denial, to explain its clinical reasoning for your diagnosis, and to answer the evidence your doctor relies on.
Appeal: formulary exception
Asks your plan to cover a drug that is not on its drug list, or to lift a quantity limit, using your prescriber's reasons why the covered alternatives do not fit.
Appeal: level of care
Asks your plan to approve the level or setting of care your clinician recommended, such as a hospital stay or residential program, instead of a lower one.
Appeal: not medically necessary
Asks your plan to reverse a medical necessity denial, using the plan's own standard and your records, and to have a clinician in the right field review it.
Appeal: mental health or substance use care with a parity argument
Asks your plan to reverse a mental health or substance use denial and to produce its criteria and comparative analysis under the federal parity law.
Appeal: not a covered benefit
Asks your plan to name the exact provision it relied on and to cover care that falls within a benefit your plan document describes.
Appeal: out of network because no in-network option exists
Asks your plan to cover out-of-network care at the in-network level because no in-network provider could give the care in time, or at all.
Appeal: out-of-network allowed amount too low
Asks your plan to explain how it set the allowed amount for out-of-network care, to reprocess the claim if the method was wrong, and to pay the difference.
Appeal: prior authorization denied
Asks your plan to reverse a refusal of approval before care, to say what standard it applied, and to decide with a clinician in the right field.
Second-level internal appeal
Asks for a second review inside your plan after a first appeal was denied, answering the first decision's reasons and adding what is new.
Appeal: step therapy exception
Asks your plan to excuse you from trying other drugs first, using the drugs you have already tried and your prescriber's reasons, and to send its step therapy rules.
Appeal: filed too late
Asks your plan to accept a claim it called late, by showing when it was first sent, quoting the plan's own filing rule, and asking it to apply any exception it contains.
Ask your plan to reprocess a claim under the No Surprises Act
Ask your plan to reprocess a claim with the No Surprises Act protections, so you pay only in-network cost sharing that counts toward your in-network limits, and to treat the letter as an appeal if the claim stays denied.

Private: nothing leaves this tab
General information, not legal advice

What it asks, and what it is not

What it asks. The denial reason, the facts of your claim, and what you want the plan to do.

Everything you type stays in this browser tab. Nothing is sent anywhere, and no account is needed.

What it is not. It assembles a letter from reviewed wording and your own facts. It leaves blanks rather than inventing medical details, and it does not send anything.

Related guides and checklists

Guide

How to assemble and send an appeal packet

Put your appeal letter, your doctor's letter, records and plan documents in order, then send the packet so you can prove the plan received it. Includes a check of what to enclose and what to keep.
Guide

How to write an appeal letter that works

A plain structure for your appeal letter, from what you want to a request for a written decision. Includes what to put in each part, what to leave out, and links to letters for each denial reason.
Guide

Writing your personal statement

How to write a short, honest account of what your condition and the denial have done to your health and daily life, to sit beside your doctor's letter in an appeal. Includes prompts and what to leave out.

Part of Build your case · Write your appeal · My Plan

What was the reason for the denial?

The most common reasons

Or, if this is you

Related guides and checklists

How to assemble and send an appeal packet

How to write an appeal letter that works

Writing your personal statement