AppealRNby Donna Lee Health

Your insurance said no. Let's appeal it.

Answer a few questions about your denial. You get a ready to send appeal letter, your filing deadline, a list of what to attach, and the next step if the plan says no again.

4 steps about 5 minutes

Free letter and deadline

Optional RN review

Your coverage

This sets your deadline and appeal path.

Medicare AdvantageA private Medicare plan such as Humana, UHC, Aetna Medicare Original MedicareRed, white and blue Medicare card, denial on a Medicare Summary Notice Medicaid managed care planTennCare, Sunshine Health, Medi-Cal plans and similar Job based or Marketplace planEmployer insurance or a HealthCare.gov plan

Who is writing this appeal?

The denial

Look at the denial letter or Explanation of Benefits.

Why did they deny it? What was denied?

Date on denial notice

Date of service optional

Has the service already happened? This is urgentWaiting could seriously harm health, life or the ability to regain function. You can ask for a fast appeal.

Names and numbers

These go at the top of the letter so it gets matched to the right file.

Patient full name

Date of birth optional

Member ID

Insurance company Claim or reference number optional Treating provider Your name and phone if not the patient

The medical story

Plain words are fine. Facts win appeals: dates, test results, what was tried and what happened.

Diagnosis or condition What is going on and why this is needed What has already been tried optional What happens if it is not approved optional The doctor supports this appealA letter of medical necessity from the doctor is the strongest attachment.

Your appeal kit shows up here

Fill in the steps on the left. Your letter updates as you type.

AppealRN is an educational tool and is not legal advice. Always check the deadline printed on your own denial notice, since some plans and states allow more time. Deadlines here follow CMS rules for Medicare Advantage reconsiderations, 65 days from the notice; Original Medicare redeterminations, 120 days from receiving the notice; federal Medicaid managed care rules, 60 days to appeal to the plan; and ACA rules for job based and Marketplace plans, 180 days for an internal appeal and 4 months for external review. Information you type stays in your browser.