Use this checklist if your health insurance refuses to pay for a service. It will guide you through gathering what you need to fight the denial.

Understand the Denial

Read the denial letter or Explanation of Benefits carefully.
Look for the exact reason the service was denied.
Find out if they need more information or if it is not covered.
Check the deadline to file your appeal.
Call your insurance to ask for details if you are confused.

Gather Your Evidence

Get a letter of medical necessity from your doctor.
Collect your medical records related to the denied service.
Make copies of any prescriptions or doctor notes.
Print out the part of your insurance policy that shows coverage.
Keep the original denial letter in your file.

Write Your Appeal Letter

Include your name, policy number, and claim number.
State clearly what was denied and why you are appealing.
List the medical reasons why you need the treatment.
Mention the documents you are attaching to the letter.
Keep the letter respectful and stick to the facts.

Submitting the Appeal

Make a copy of the final letter and all attachments for yourself.
Send the appeal by certified mail if you are mailing it.
Keep the tracking receipt to prove when it arrived.
Call the insurance company to confirm they received it.
Ask about your right to an ERISA external review if your internal appeal is denied.

Tip: Always check your specific plan's rulebook to confirm exactly where to send your appeal and how many days you have to send it.

This checklist is educational information only. It is not medical, legal, or financial advice. Confirm details with your insurer, provider, or an official government source.

Appeal Preparation Checklist

Understand the Denial

Gather Your Evidence

Write Your Appeal Letter

Submitting the Appeal