How to Appeal a Denied Insurance Claim
A denied claim doesn't mean you're stuck paying. Most denials can be overturned if you know the process. Here's how to file an appeal, what to include, and the deadlines you need to know.
Types of Denials
- Prior authorization — Service wasn't pre-approved
- Medical necessity — Insurer says the treatment wasn't necessary
- Out-of-network — Provider wasn't in your network
- Coding errors — Wrong codes submitted on the claim
The Appeal Process
You typically have 180 days to file an internal appeal. Include your denial letter, medical records supporting the treatment, and a letter from your doctor explaining why it was necessary. If the internal appeal fails, you can request an external review by an independent third party.