Insurance Denial Appeal Templates
50% of insurance denials are overturned on appeal—but only if you appeal correctly.
Most people accept the first denial. Don't be one of them.
Basic Appeal Letter Structure
[Your Information]
Your name, address, policy number, claim number
[Clear Statement]
"I am appealing your denial of [service] on [date]."
[Why They're Wrong]
Choose your argument:
- "This service IS medically necessary because..."
- "My policy DOES cover this, as stated on page..."
- "I DID obtain prior authorization #..."
- "This WAS coded incorrectly; correct code is..."
[What You're Attaching]
- Doctor's letter of medical necessity
- Medical records
- Policy language
- Clinical studies
- Prior authorization
[Clear Request]
"I request you overturn this denial and provide coverage as required by my policy."
Sample Opening Paragraph
"I am writing to formally appeal your denial of coverage for [MRI/surgery/medication] performed on [date]. According to your denial letter, you denied this claim stating it was 'not medically necessary.' This denial is incorrect. My physician prescribed this treatment specifically because..."
Common Denial Reasons & How to Fight Them
| Denial Reason | Your Response |
|---|---|
| "Not medically necessary" | Get detailed letter from your doctor explaining WHY it's necessary |
| "Experimental/investigational" | Show FDA approval and clinical studies proving it's standard care |
| "Not covered under your plan" | Quote specific policy language that covers it |
| "Didn't get prior authorization" | Show you did, or explain why it was emergency |
| "Out of network" | Prove no in-network alternative exists |
3 Critical Appeal Tips
- Don't miss deadlines - Usually 180 days to appeal
- Include doctor's letter - Medical necessity from your physician is powerful
- Keep appealing - Internal appeal → External appeal → State complaint
When You Need Expert Help
Whether your denial involves a simple medication refusal or a complex treatment plan, we're here to help. No case is too small or too large.
Professional advocates know the exact language insurers respond to. We know how to build winning appeals and fight for the coverage you deserve.
At BillAlly, we handle everything—you just provide the documents.
$100 per appeal, only charged if successful. Complex cases may incur additional charges.