Second-level internal appeal
Asks for a second review inside your plan after a first appeal was denied, answering the first decision's reasons and adding what is new.
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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. Use this only if your plan has two internal appeal levels and the first-level decision upheld the denial. A group health plan may not require more than two appeals; an insurer offering individual coverage provides one. If your plan has only one, ask for external review instead.
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: Second-level internal appeal Plan: [Name of the health plan] Member ID: [Member ID] Claim or reference number: [Claim or reference number]
To the reviewer:
I am filing my second-level appeal of the decision dated [Date of the first-level appeal decision], which upheld the denial of [The care or drug that was denied] ([Date of the care], [Doctor, hospital or pharmacy]) under [Name of the health plan], member ID [Member ID]. My first appeal was filed on [Date you filed the first appeal]. The original denial was dated [Date on the denial notice] on claim [Claim or reference number]. I ask you to reverse both decisions and approve and pay for this care.
The first-level decision gave these reasons: [The reasons the first-level decision gave]
Those reasons are wrong or incomplete because: [What the first-level decision got wrong or did not address]
What is new since my first appeal: [What is new since the first appeal] My treating doctor is [Your treating doctor's name and specialty].
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), I am entitled to a full and fair review. I ask that someone who was not involved in the earlier decisions, and who is not their subordinate, decide this appeal and give no deference to them. I ask you to consult a health care professional with training and experience in the field of my condition who was not consulted on the earlier decisions. If you rely on any new or additional evidence or reasoning, I ask you to send it to me free of charge, early enough for me to respond before you decide.
Please send me your decision in writing within the time the rules allow. If you uphold the denial again, I will ask for external review by an independent organization and may complain to the agency that regulates my plan.
Enclosures: 1. Copy of the first-level decision letter 2. Copy of my first appeal and the original denial 3. New records or test results 4. Letter from my treating doctor, if I have one
Sincerely, [Your name]
Before you send it
Send it to the appeals address printed on your denial notice, by a method that proves delivery, such as certified mail with a return receipt or the plan's online portal with a saved confirmation page. Keep a complete copy of the letter and everything you enclose, and write down the date and the method you used.
What to enclose
- Copy of the first-level decision letter
- Copy of my first appeal and the original denial
- New records or test results
- Letter from my treating doctor, if I have one
What happens next
- Your plan must decide within 30 days after it receives this appeal if the care has not happened yet, or within 60 days if you have already had it. Where a plan has two levels, the time at each level is half of that: 15 or 30 days. Check the date on your notice, which controls.
- Check the deadline for this second appeal in your first-level decision letter. For most job-based plans the federal minimum for appealing is 180 days after you receive the denial notice, but your plan may allow more, and the date on your notice controls.
- If the plan says no again, or does not answer in time, ask for external review (also called independent review), which is a review by reviewers outside the plan. For most job-based and individual plans you have at least four months after you receive the final denial to ask. Check the date on your notice, which controls.
- You can also complain to the agency that oversees your plan. Filing a complaint is not a substitute for an appeal, so file the appeal first and by the date on your notice.
- 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".