How to appeal a health insurance denial
A denial isn't always final. Under federal rules, you can ask your plan to reconsider through an internal appeal.
Key deadlines (from HealthCare.gov)
- File within 180 days (6 months) of receiving the denial notice.
- The plan must decide within 30 days for care you haven't received yet, and 60 days for care you've already received.
- Urgent cases can be expedited.
What to include
- The denial letter and claim number
- A letter explaining why the care should be covered
- A letter of support from your doctor, if you can get one
- Relevant medical records and plan language
KFF found that HealthCare.gov consumers appealed fewer than 1% of denied in-network claims in 2024, so many people never use this right.
General information, not legal advice.
Sources
- HealthCare.gov: Internal appeals
- HealthCare.gov: Appealing a health plan decision
- KFF: Claims denials and appeals in ACA Marketplace plans in 2024
Rules change and plans differ. Always check the official page and your own plan documents.