What you can do when an insurer says no.

Federal law requires every insurer to send a written denial letter that explains why the claim was denied and how to appeal it. If you got a verbal 'no' on the phone, ask for the letter. They have to send it.

You can request. In writing. The specific clinical or coverage criteria the carrier used to deny your claim. They are obligated to provide this. It is one of the most useful things you can ask for, because it gives you the rebuttal map.

Every U.S. health plan must offer at least one level of internal appeal. Most ACA-compliant plans give you 180 days to file. Medicare gives you 60-120 days depending on the plan type.

After exhausting internal appeal, you have the right to an external review by an independent third party. The carrier is bound by the result. This right is set by federal law and strengthened in many states.

If delay would seriously jeopardize your health, you can request an urgent or expedited review. Standard 30-day windows compress to 72 hours.

You can authorize someone. A family member, an advocate, or our team. To act on your behalf during appeals. Federal law and HIPAA both recognize this designation. It does not give that person ownership of your case; you remain in control.

Every state has an insurance department (or its equivalent) that accepts consumer complaints. A formal state complaint is independent of the appeal process and often accelerates carrier response.

Most denials reverse on appeal. The carrier counts on you giving up. Don't.