How to Appeal a Denied Claim

Start with the denial reason

Read the Explanation of Benefits and denial letter. Note whether the issue is medical necessity, coding, out-of-network, or prior authorization.

Ask your clinician for supporting notes. Many denials reverse when the right documentation arrives.

Internal then external review

File the plan's internal appeal on time. If denied again, you may have external review rights under federal or state rules.

Keep a paper trail: dates, reference numbers, and copies of everything submitted.

Frequently asked questions

How long do I have to appeal?

Deadlines vary by plan — often 180 days for internal appeals. Check your denial letter.

Can an agent appeal for me?

Sometimes; you can also authorize your clinician's office. You remain responsible for deadlines.