You opened the envelope expecting help.

Instead, you got a denial—and now your medical treatment is in limbo.

But that “no” doesn’t have to be the end.

With the right steps and a little strategy, you could turn it into a “yes.”



Insurance denials are rising—but so are successful appeals.

With healthcare costs climbing, knowing how to fight back isn’t just helpful—it’s essential.

Experts say up to 60% of denials can be reversed with a well-documented challenge.

Here’s how to take control of your claim, one smart step at a time.


Step 1: Review the Denial and Your Policy

Start by reading your denial letter carefully and identifying the reason.

Is it labeled “not medically necessary,” “experimental,” or “out of network”?

Then compare it with your insurance’s fine print, often called your Summary Plan Description.

Flag vague language—like “investigational”—that you can challenge later.



Step 2: Call Your Insurance Company

Get on the phone and request the medical policy used to deny your claim.

Ask if a specialist in your condition was the one who reviewed it.

Take notes during every call—dates, names, and what was said.

Send a follow-up email summarizing the call to build your paper trail.



Step 3: File an Internal Appeal

This is where documentation becomes your superpower.

Write a detailed appeal letter addressing every reason for denial, and include your policy number and claim ID.

Most importantly, include a letter from your doctor outlining medical necessity and citing clinical guidelines.

Submit it before your plan’s deadline—usually 60 days—and request a written receipt.



Step 4: Request a Peer-to-Peer Review

Your doctor can request a phone conversation with the insurance company’s medical director.

This must usually happen within 72 hours of the denial.

Before the call, provide your doctor with medical research and ask for a specialist reviewer.

Document the outcome and request written proof, even if it’s another denial.



Step 5: Escalate to External Review

If internal appeals fail, you’re entitled to a third-party review under the Affordable Care Act.

This independent medical team has no ties to your insurance provider.

Submit new documents—such as recent test results or updated treatment guidelines—and respond directly to the denial’s reasons.

Check your state’s options, like California’s free Independent Medical Review.



Step 6: File a Complaint or Consult Legal Help

State insurance departments can investigate unfair denials or violations of the law.

For complex or potentially illegal rejections, consult a healthcare attorney.

Nonprofits may offer free legal consultations for denied patients.

In urgent situations, lawyers can sometimes request temporary court orders to force coverage.



Step 7: Go Public If Needed

If all else fails, public pressure can be a game-changer.

Send your story, medical proof, and appeals history to your insurer’s CEO, state reps, or local news.

Contacting elected officials can also trigger action—insurers don’t like public scrutiny.

Many patients have seen decisions reversed thanks to social media campaigns and media attention.



Don’t Give Up: Most Patients Win

Insurers often count on your silence after a denial.

But data shows that persistent patients often win, especially when they build a strong case.

Stay organized, stay focused, and stay informed.

Because when it comes to your health, you have more power than they expect.

Have you or someone you know ever fought an insurance denial? What worked—or what do you wish you’d done differently? Share your experience in the comments—your story could help someone win their fight, too.