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Answer

How do I prepare an appeal?

The short answer

An appeal asks your plan to review a denial. Read the notice for the reason and deadline. Gather records that answer that reason, often with a letter from your clinician. Send it as the notice says, and keep copies. If the plan still says no, outside review may be available.

Key takeaways

  • Your notice lists the deadline. Many plans allow 180 days for an internal appeal.
  • The strongest appeals respond directly to the reason for the denial.
  • If waiting could seriously harm your health, ask for an urgent (expedited) review.

What you can do next

  1. Write your appeal deadline on a calendar today.
  2. Ask your clinician's office for a letter of medical necessity and records.
  3. Open the printable appeal checklist and work through it one item at a time.

Read the full lesson

Words in this lesson

Appeal
A formal request asking your plan to review and change a decision, such as a denied claim or prior authorization.
External review
A review of your plan's decision by an independent organization, usually after an internal appeal.
Expedited (urgent) appeal
A faster review when waiting for a standard decision could seriously harm your health.
Medically necessary
Care your plan agrees is needed to diagnose or treat a health condition, based on its rules. Plans may deny care they consider not medically necessary.

Related

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

Sources

  1. 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.
  2. Internal appeals HealthCare.gov (Centers for Medicare & Medicaid Services). Applies to: current page. Published or updated: Unknown. Retrieved: October 14, 2026.
  3. External review HealthCare.gov (Centers for Medicare & Medicaid Services). Applies to: current page. Published or updated: Unknown. Retrieved: .
  4. Medicare.gov Centers for Medicare & Medicaid Services. Applies to: current site. Published or updated: Unknown. Retrieved: .