Health insurance said no? Here is what to do next.

My claim was denied. What do I do?

"Denied" means your health plan said no. You can ask them to look again. That is called an appeal. It is free, and you have the right to do it. Answer four questions and we will show your steps and your deadline.

Write your appeal letter

Fill in what you know. Empty boxes show as [brackets] in the letter so you can fill them in by hand. The letter is firm and polite. It asks the plan to look again and to send you, for free, the papers and rules it used.

The letter type follows your answer to question 1. Pick "Medicare" or "Medicaid" there and the letter changes to fit.

Your letter

Before you send it

• Sign it and keep a copy.
• Add copies (not originals) of the denial letter and any doctor letters or records.
• Send it the way your denial letter says. If you mail it, ask the post office for proof that it was delivered.
• Write down the date you sent it.

What to say when you call

Call the member services number on the back of your insurance card. Have your card and the denial letter in front of you. Write down the date, the time and the name of each person you talk to.

A phone call is a good start, but send the appeal in writing too, unless your letter says a phone appeal is enough. A written appeal leaves a record.

Why bother appealing?

Few people appeal. When they do, the plan often changes its answer. These are the latest figures we found.

KFF is an independent health policy research group. Both reports analyze data insurers report to the federal government. The Marketplace figures cover HealthCare.gov insurers only, not job plans. An appeal is not a sure thing, and these numbers do not predict any one person's result.

For analysts, employers and reporters: count rate vs dollar rate

A plan's denial rate is usually counted by claims: denied claims divided by all claims. But a $25 lab claim and a $50,000 surgery claim each count as one. If a plan approves nearly all small claims and denies more large ones, the count rate can look low while a much bigger share of the dollars is denied. Grouping claims by cost shows this.

Where the denials sit

How we calculate

• Count rate = all denied claims / all claims.
• Dollar rate = sum of (denied x average amount) / sum of (claims x average amount), across bands.
• Top-band share = the top band's denied dollars / all denied dollars.
• Within one band we have only one average amount, so a band's count rate and dollar rate are the same. The difference shows up when bands are added together.
• Appeals: appealed / denied, and overturned / appealed, by count and weighted by each band's average amount.
• Using an average per band is an estimate. Real claim amounts inside a band vary.

What is published today

In the federal and state sources we checked, denials are reported as counts or percentages, not by dollar amount or claim cost. CMS's Marketplace transparency data count claims received, denied and appealed (CMS data dictionary). KFF notes insurers do not report what types of services were denied (KFF). The new federal prior approval reports are percentages for all services combined (KFF). Massachusetts' 2024 state analysis counts claim lines (Mass. Health Policy Commission). We did not find any insurer or government dataset that reports denial rates by claim cost. We have not checked every insurer's own reports; if you know of one, tell us and we will add it.

Where every number comes from

We read each of these on November 13, 2026. Every deadline, phone number and figure on this page traces to one of them. Our full research log, with the exact rule, who it applies to and a short quote, is public: research-log.txt.