Question 1

How do I appeal an insurance denial?

Accepted Answer

Start by understanding your denial reason, then file an internal appeal within 180 days with supporting documentation. If denied again, you can request an external review or file a complaint with your state Department of Insurance.

Question 2

What is the deadline to appeal an insurance denial?

Accepted Answer

Most insurance companies allow 180 days (6 months) from the denial date for internal appeals. External review deadlines vary by state, typically 4-6 months. Always check your specific plan documents for exact timeframes.

Question 3

What should I include in an appeal letter?

Accepted Answer

Include your denial reference number, specific reason for appeal, supporting medical documentation, clinical justification for medical necessity, and a clear request for reconsideration. Be professional, factual, and concise.

Question 4

What is the difference between internal and external appeal?

Accepted Answer

Internal appeals are reviewed by the insurance company. If denied, external appeals go to an independent third-party reviewer mandated by state or federal law. External reviewers are not employed by the insurance company.

Question 5

Can I appeal if my claim was denied as not medically necessary?

Accepted Answer

Yes. Provide additional clinical documentation, peer-reviewed studies, and a letter from your physician explaining why the service was medically necessary for your specific condition.

Insurance Appeal Assistant

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