Insurance companies deny claims for many reasons, but you have the right to appeal. This playbook shows you how to fight back effectively.
Understand the denial
Read the denial letter carefully. Identify the specific reason for denial and what evidence might change the decision.
- Coverage exclusions or limitations
- Pre-existing condition claims
- Medical necessity disputes
- Documentation insufficiency
- Deadline or procedural issues
Build your appeal
Gather supporting documentation, medical records, and any letters from doctors supporting your claim.
Internal vs external appeals
Most policies require an internal appeal first. If that fails, you can often request external review by an independent party.
When to escalate
If appeals fail, consider filing a complaint with your state insurance commissioner or consulting an attorney.
Resource FAQ
How long do I have to appeal?
Deadlines vary but are typically 30-180 days. Check your denial letter for the specific deadline.
What is bad faith insurance?
Bad faith is when an insurer unreasonably denies or delays valid claims. This may entitle you to additional damages.
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