Request an expedited appeal
Asks your plan to decide an appeal as an urgent claim, within 72 hours, because waiting could seriously harm your health, and to contact your doctor.
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- A template, not legal advice
This one is for a specific kind of coverage
It is written for the coverage tagged above. If you have a different kind (for example Medicare or Medicaid instead of a job-based or individual plan), it may cite the wrong rules. Check what kind of coverage you have and use the letter written for it.
When to use this, and what it is not
When to use this. This letter is for private job-based and individual plans (including Marketplace plans). If you have Medicare and a hospital stay, or skilled nursing facility, rehabilitation or home health care, is ending, use the phone script (“Phone script: ask Medicare for a fast appeal when care is ending”) instead. If you have a Medicaid health plan that is cutting or ending your services, use the letter "Appeal my Medicaid plan's cut and keep my services going". Use this only when waiting the normal time could seriously jeopardize your life, your health or your ability to regain maximum function, or when your doctor says the care is urgent. You can also ask by phone. Call the number on your notice and write down the reference number.
This is a template, not legal advice. Read it, change anything that is not true for you, and send it only when you are satisfied. Your notice and your plan document control.
Fill in the letter
Your letter
[Your name] [Your address]
13 November 2026
[Name and address of the plan's appeals department]
Re: Request an expedited appeal Plan: [Name of the health plan] Member ID: [Member ID] Claim or reference number: [Claim or reference number]
To the reviewer:
I am requesting an expedited appeal of the decision dated [Date on the denial notice] on claim [Claim or reference number], which denied [The care or drug that was denied] under [Name of the health plan], member ID [Member ID]. The plan's reason was: [The reason the plan gave] I ask you to reverse that decision and approve this care.
This is a claim involving urgent care. Waiting for a standard decision could seriously jeopardize my life, my health or my ability to regain maximum function, or, in the opinion of my physician who knows my condition, could cause severe pain that cannot be adequately managed without the care. [What could happen if you wait]
My treating doctor, [Your treating doctor's name and specialty], knows my condition and can be reached at [Your doctor's office phone number]. If a physician who knows my condition says this claim is urgent, the rules require the plan to treat it as urgent, and a plan that is not grandfathered must defer to the attending provider's decision. I ask you to call my doctor's office to confirm.
Under the federal claims and appeals rules, including Title 29 of the Code of Federal Regulations (CFR), sections 2560.503-1 and 2590.715-2719 (for individual coverage, 45 CFR 147.136), an urgent appeal must be decided as soon as possible and no later than 72 hours after you receive it. An urgent appeal may be requested orally or in writing, and information can move between us by telephone, fax or a similarly fast method. I can be reached at [A phone number or fax where you can be reached today]. If you decide not to treat this request as urgent, please tell me at once and treat it as a standard appeal in the meantime.
I ask that someone who was not involved in the first decision, and who is not that person's subordinate, decide this appeal and give no deference to the first decision, and that you consult a health care professional with training and experience in the field of my condition who was not consulted on the first decision. Please tell me the decision by phone and send it in writing. If you uphold the denial, I will ask for expedited external review at once.
Enclosures: 1. Copy of the denial letter 2. A written statement from my treating doctor that the claim is urgent 3. Relevant pages of my medical records
Sincerely, [Your name]
Before you send it
Send this by the fastest method the denial notice allows, such as fax or the plan's portal, and also call the number on the notice to ask for an expedited appeal. Write down the date, the time, the name of the person you spoke to and a reference number. Keep a copy of everything you send.
What to enclose
- Copy of the denial letter
- A written statement from my treating doctor that the claim is urgent
- Relevant pages of my medical records
What happens next
- Your plan must decide an urgent appeal as soon as possible and no later than 72 hours after it receives it. Seventy-two hours is a ceiling, not a target. Check the date on your notice, which controls.
- Call the plan again within a day if you have not heard, and ask your doctor's office to call too. Write down each call.
- If the plan says it will not treat the appeal as urgent, or says no again, you can ask for expedited external review. You can ask for it at the same time as the urgent internal appeal when waiting would seriously jeopardize your health or ability to regain maximum function.
- If your life or health is in danger now, get medical care first; do not wait for the plan.
- If you are writing for someone else, tick "I am writing for someone else". The plan may require its own authorization form. See the letter "Name someone to act for you".
The rule behind this
Sources
Denial reasons this answers
- Denial reason
Prior authorization denied
Your doctor asked the plan to approve care in advance and the plan said no. The clocks are short, and your doctor can ask for a doctor-to-doctor call. Independent external review is open if the reason is medical and your plan is not grandfathered.
- Denial reason
Not medically necessary
The plan says the care is not needed under its own definition. That is a medical judgment, so your doctor's letter carries the appeal. Independent external review is open if your plan is not grandfathered, short-term, fixed indemnity or a sharing ministry.
- Denial reason
Care is ending
Hospital, rehab, nursing home or home health care ending? Medicare: call the reviewer on your notice by noon the day after you get it, or 1-800-MEDICARE (1-800-633-4227). Medicaid or job-based plan: see What to send.