How to appeal an insurance denial

The internal appeal process

Under the ACA, you have the right to an internal appeal for most denied claims. The insurer must respond within set timeframes — typically 30 days for non-urgent and 72 hours for urgent situations.

1. Review the denial letter — identify the specific reason and appeal deadline
2. Gather supporting documentation — medical records, doctor's letters, clinical guidelines
3. Write a formal appeal addressing the specific denial reason
4. Submit before the deadline (usually 180 days from denial)
5. Request written acknowledgment of receipt

Peer-to-peer review

For medical necessity denials, your doctor can request a peer-to-peer review — a direct conversation with the insurer's medical reviewer. Often one of the most effective ways to overturn a denial.

External independent review

If the internal appeal is denied, you have the right to an external review by an independent organization. The decision is binding on the insurer.

General information only. Not legal or medical advice.