Ask your employer to review the denial
A polite written request to your employer's benefits office to look into a denial, name the plan administrator and send the plan documents.
- Private: nothing leaves this tab
- 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. When your coverage comes through your job and your claim or appeal was denied. Your employer may or may not be able to change a decision: many employer plans use an insurance company or claims administrator to decide claims, and the employer may only fund the plan. This letter does NOT replace an appeal and does not stop any deadline, so file your appeal at the address on your denial notice at the same time. If you work for a government employer or a church, the Employee Retirement Income Security Act (ERISA) may not apply; ask human resources what law governs the plan.
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 of your employer's benefits or human resources department]
Re: Ask your employer to review the denial Plan: [Name of the health plan] Member ID: [Member ID] Claim or reference number: [Claim or reference number]
To whom it may concern:
I am a participant in the health plan offered through your company, [Name of the health plan]. My member identification (ID) number is [Member ID]. I am writing for help with a denied claim, number [Claim or reference number].
On [Date on the denial notice] the plan denied [The care or drug that was denied], provided or requested on [Date of the care] by [Doctor, hospital or pharmacy]. In short: [In one or two sentences, why the denial is wrong]
I have filed, or will file, my appeal by the deadline on the denial notice. I am not asking you to skip that step. I am asking for three things:
1. Please ask the plan administrator, or the company that decides claims for the plan, to take a second look at this denial, and tell me who you contacted and when. 2. Please tell me in writing who the plan administrator is, and whether the plan is self-funded (paid by the company) or insured (bought from an insurance company). 3. Please send me the latest summary plan description and the documents under which the plan is set up and run. If my plan is covered by the Employee Retirement Income Security Act (ERISA), I understand it requires the plan administrator to furnish these on written request. I ask for them within 30 days, and I will pay a reasonable copying cost.
Please let me know by [Date by which you ask for a reply] what you are able to do. Thank you for your help.
Enclosures: 1. Copy of the denial notice 2. Copy of your appeal letter, if you have sent it
Sincerely, [Your name]
Before you send it
Address it to the human resources or benefits office, and also to the plan administrator named in your summary plan description if you know who that is. Hand it in and ask for a signed receipt, or send it by mail with tracking. Keep a copy.
What to enclose
- Copy of the denial notice
- Copy of your appeal letter, if you have sent it
What happens next
- File your appeal on time with the plan, whatever your employer says. For most job-based plans you have at least 180 days after receiving the denial notice to file a first appeal. Check the date on your notice, which controls.
- Whether your employer can change a decision depends on how the plan is set up. Do not wait for a reply before you appeal.
- Write down the date you sent this letter. If the plan documents have not arrived within 30 days, say so in a follow-up note.
- If you get no reply, or the answer is no, ask the Department of Labor for help. The Department of Labor help request letter on this site is written for that.
- If you are writing for someone else, tick "I am writing for someone else". The office you are writing to may require its own authorization form. See the letter "Name someone to act for you".