Guides

Plain-language explanations of the appeal process. Use the cluster pages for action; use these for the rules behind them.

How to write a health insurance appeal letter
A step-by-step structure for an appeal letter that cites the insurer's own policy and the records that support your case.
Internal appeal vs external review: what is the difference
Internal appeals go to the insurer. External review goes to an independent third party. Here is when each applies and the order they happen in.
Expedited appeals: when to ask for an urgent review
If waiting on a standard appeal would seriously jeopardize your health, you can request an expedited (urgent) appeal with a 72-hour turnaround.
The No Surprises Act and out-of-network bills
The federal No Surprises Act protects against most surprise out-of-network bills for emergency care and certain in-network facility services. Here is what it covers and how to invoke it.
Health insurance appeal deadlines you need to know
Federal rules give you 180 days to file an internal appeal and 120 days to request external review. Here are the deadlines by plan type.
How to get the medical policy your insurer used to deny you
Most insurers publish their clinical policy bulletins online. Here is how to find the exact policy that drove your denial and use it in your appeal.
ERISA appeal rights: what your employer-sponsored plan owes you
If your coverage comes through a job, ERISA sets the floor for how denials must be handled, what the plan must disclose, and how long you have to appeal.
Medicare Advantage appeals: the five levels explained
Medicare Advantage (Part C) denials follow a specific five-level appeal track set by 42 CFR Part 422. Here is what each level looks like and the deadlines that apply.
Medicaid fair hearing: how to challenge a denial or termination
Federal law guarantees a Medicaid fair hearing when your benefits are denied, reduced, or terminated. Here is the process, the deadlines, and how to keep benefits during the appeal.
Letter of medical necessity: the template that maps to policy criteria
A letter of medical necessity (LMN) carries weight only when it speaks the insurer's language. Use this structure to map your records to each criterion in the clinical policy.
Prior authorization denials: how to appeal and what the new federal rule changes
Prior auth denials are the most common reason care gets blocked. Here is the appeal path, the federal rule that tightens turnaround times in 2026, and the leverage points that work.
Step therapy: how to get an exception when the required drug is wrong for you
Step therapy forces patients through cheaper drugs first. Federal and state law require an exceptions process — here is how to invoke it and what evidence wins.
Independent medical review: how external review works in your state
After the final internal denial you have a federal or state right to independent medical review. Here is how the two tracks differ and how to file in your state.
EMTALA: your right to emergency care and what insurers cannot deny
EMTALA guarantees a screening exam and stabilizing treatment at any hospital with an emergency department. Here is how it interacts with insurance denials and the No Surprises Act.
Bariatric surgery denials: how to appeal when coverage is blocked
Bariatric surgery denials usually cite missing supervised weight-loss documentation or BMI thresholds. Here is how to map your record to the policy and what the strong specialty guidelines say.
IVF and fertility treatment denials: state mandates, plan exclusions, and appeals
IVF coverage depends heavily on state mandate law and whether your plan is fully insured or self-funded ERISA. Here is how to appeal and where state law gives you leverage.
GLP-1 for weight loss: the exceptions process when coverage is denied
Wegovy, Zepbound, and Saxenda denials usually cite plan exclusions or missing documentation. Here is how to invoke the exceptions process and when an appeal can win.
Mental health parity: how to appeal when coverage is more restrictive than medical care
The Mental Health Parity and Addiction Equity Act bans plans from imposing tougher limits on mental health than on medical care. Here is how to use parity in your appeal.
Proton beam therapy denials: how to win the medical necessity argument
Proton therapy is denied as experimental for many adult cancers. Here is the evidence base that wins appeals and the diagnoses where coverage is generally accepted.
MRI and PET imaging denials: appeals when prior auth blocks advanced imaging
Advanced imaging denials usually cite missing conservative treatment, low pre-test probability, or appropriate-use criteria. Here is how to satisfy the criteria and win the appeal.
Genetic testing denials: when coverage is required and how to appeal
Genetic and genomic testing is one of the most denied service categories. Here is when coverage is required by guideline and how to map the appeal to the insurer's criteria.
Gender-affirming care denials: ACA Section 1557, WPATH guidelines, and appeals
Gender-affirming care denials are governed by ACA Section 1557 anti-discrimination rules, state law, and WPATH Standards of Care. Here is how to appeal effectively.

Not legal or medical advice. This page is a self-help resource. You make your own decisions. Strip personal identifiers (name, date of birth, address, member ID) from any document before uploading or sharing. The information here summarizes commonly-published payer policies and federal rules; confirm against your specific plan document and the current denial letter before acting.