Appeal

After a final denial

See every option left: the employer, a lawsuit, a new request, the bill, and other ways to get the care.

Do this today

This week: write down the date on the letter, ask for outside review if you have not, call the hospital billing office, and call the right help line. Outside review is due within four months for most private plans.
The options that remain depend on your plan: asking a self-funded employer, a new request with new evidence, the regulator, a lawsuit, or dealing with the bill.
None of these is guaranteed. A lawyer can tell you whether a lawsuit is realistic and what time limits apply.

More guides, tools, letters 4

After a final denial: every option left
What to check after a plan's final denial. Look at outside review, your employer, a new request, the regulator, a lawsuit, the bill, other ways to get care, and legal help.
Asking your employer to overrule a denial
If your employer pays your health claims itself, a request to the employer or its human resources team can sometimes lead to an exception. Learn how to ask, what to say, and why this is a request, not a right.
Suing your health plan
What federal law says about suing a health plan over a denial, how it differs for employer plans and other coverage, and why time limits in your plan documents matter. This is information, not legal advice.

Tool

Employer escalation builder

Build a request asking your employer's benefits team to step in, with a script for the conversation.

Questions to keep handy

Your notice or plan document controls if it differs from a general rule. Keep a copy of everything and the date and way you sent it.

Sources last checked 12 November 2026. Found a mistake? Report it.