Insurance appeal letter templates
Free, fillable appeal letter templates for every health-insurance denial type. Copy, fill in your details, and send. Each one is built on the structure that actually overturns denials, not a generic reconsideration request.
Pick your denial type
Each template is tailored to the standard that controls that denial.
The general appeal letter template
A starting point for any denial. For the exact controlling standard, use the denial-specific template above.
[Date] [Your full name] · [Address] · [Phone] · [Email] [Insurer name], Appeals Department [Appeals address from your denial letter] Re: Appeal of denied claim Member: [Patient name] · Member ID: [ID] · Group: [Group #] Claim #: [Claim #] · Date(s) of service: [Dates] Denial date: [Date] · Denial/reason code: [Code] To the Appeals Department: I am formally appealing [Insurer]'s [denial date] denial of [service or medication]. I request that the denial be overturned and the service approved. 1. The denial. [Insurer] denied this claim stating, verbatim: "[paste the exact denial language]." 2. Why the denial is incorrect. [Explain, specific to your condition, why the service is medically necessary and answer the exact reason given.] 3. The controlling standard. [Cite the federal rule or clinical standard that applies. See the per-denial templates for the exact standard.] 4. The evidence. Attached: a treating-provider letter of medical necessity addressing each criterion, supporting records, and the relevant clinical guidelines. 5. My request. I request a full reversal and approval within the timeframe required by law. If upheld, please provide the clinical criteria used, the reviewing clinician's credentials, and external-review instructions. Under 29 C.F.R. 2560.503-1 or 45 C.F.R. 147.136, please provide all records relevant to this claim. Sincerely, [Patient name]
The four parts of an appeal letter that works
- Quote the denial. Anchor the appeal to the plan's exact words so the reviewer cannot move the goalposts.
- Rebut the criteria. Demand the clinical criteria the plan applied, then answer each one with your medical record.
- Cite the controlling standard. The federal rule or clinical guideline that governs the decision (it differs by denial type).
- Demand reversal. A specific request to overturn and approve, not a request to reconsider.
Frequently asked questions
What should a health insurance appeal letter include?
Five things: your claim and denial details, the denial quoted verbatim, a point-by-point rebuttal of the plan's stated reason, the controlling federal or clinical standard, and a clear demand for reversal with a request for the criteria used. A treating-provider letter of medical necessity is the strongest attachment.
Are these appeal letter templates free?
Yes. Every template here is free to copy and use. Pick the template that matches your denial type, fill in the bracketed fields, attach your evidence, and send it within your appeal deadline (usually 180 days).
How long do I have to file an appeal?
For most plans you have 180 days from the date of the denial to file an internal appeal. Urgent or expedited cases are decided faster, often within 72 hours. Check your denial letter for the exact deadline.
Do generic appeal letter templates work?
A generic letter that only asks the plan to reconsider rarely works. The letters that get overturned rebut the plan's specific criteria, cite the controlling standard, and attach medical-necessity evidence. Use a denial-specific template and tailor it to your records.
Don't want to write it yourself?
Apellica builds the full evidence-based appeal for you, with the criteria rebuttal and the medical-necessity pack assembled. $0 upfront, pay only if we win.
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