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Checklist: Prepare an appeal

An appeal asks your plan to look again. Follow the instructions on your own notice.

Use your browser's print option, or the Print button. Sources and dates print too.

Understand the decision

Find the denial reason and any code
Write down the appeal deadline from your notice
Check whether this is a billing error the provider can correct first
If waiting could seriously harm your health, ask for an urgent (expedited) review

Gather evidence

Ask the plan for your claim file and the rules it used
Ask your clinician for a letter explaining why the care is needed
Collect related records, test results, and notes
Find the plan language that you believe covers the care

Send the appeal

Write a short cover letter: name, plan ID, claim number, service, and your request
Send it the way the notice says, before the deadline
Keep copies and proof of sending

After you send it

Note the date the plan should decide
If still denied, check the notice for external review or next-level steps
Consider free help from a state program, SHIP, or an advocate

Related

This is general education. For decisions about your own plan, taxes, or legal rights, check your plan documents or a qualified professional.

Review status: Draft. Version 1. Sources retrieved: October 14, 2026.

Sources

Filing a Claim for Your Health Benefits U.S. Department of Labor, Employee Benefits Security Administration. Applies to: current page. Published or updated: Unknown. Retrieved: October 14, 2026.
Internal appeals HealthCare.gov (Centers for Medicare & Medicaid Services). Applies to: current page. Published or updated: Unknown. Retrieved: October 14, 2026.