74 programs
Programs and services
These are run by other organizations. We summarize each in our own words, say when we last read its page, and say what it does not do. We do not rank them or take payment to list them.
Federal agencies
22 22 programs
22
- Program or service
1-800-MEDICARE: talk to a person about Medicare
The Medicare phone line and live chat, open all day every day. Staff can point you to the right step for a complaint, and can pass an unresolved complaint to the Medicare Beneficiary Ombudsman.
From Medicare (Centers for Medicare & Medicaid Services)
- Program or service
Beneficiary and Family Centered Care Quality Improvement Organizations: find yours
The Medicare contractors that handle fast appeals when hospital or other care is ending too soon, and complaints about the quality of care. Each state is assigned to one of two organizations.
From Centers for Medicare & Medicaid Services
- Program or service
Consumer Assistance Programs: state health insurance help
A federal map of state Consumer Assistance Programs that help people with health insurance problems by phone, mail, email or in person, and what to try if your state has none.
From Centers for Medicare & Medicaid Services
- Program or service
Consumer Financial Protection Bureau: medical bills in collections and on credit reports
Federal consumer-bureau explanation of debt collection and credit reporting rules when a medical bill goes to collections, including surprise bills, with how to dispute and where to complain.
From Consumer Financial Protection Bureau
- Program or service
Consumer Financial Protection Bureau: what to do if you cannot pay a medical bill
Federal consumer-bureau guidance on checking whether you owe a bill, looking for billing errors, using appeal rights, financial assistance and payment plans, and avoiding collections.
From Consumer Financial Protection Bureau
- Program or service
Employee Benefits Security Administration help line and Ask EBSA
Free phone and online help from federal benefits advisors for people in employer health plans. They explain your rights and possible next steps, and may help you recover benefits you are owed.
From U.S. Department of Labor, Employee Benefits Security Administration
- Program or service
Federal external review run for the Department of Health and Human Services
The federal independent review for some denied claims. A federal contractor, MAXIMUS Federal Services, reviews medical-judgment denials and coverage cancellations when your plan or state uses this process.
From Centers for Medicare & Medicaid Services
- Program or service
Filing a Claim for Your Health Benefits (Department of Labor booklet)
A plain federal booklet on the claim and appeal rules for workplace health plans: the documents to check, how to file, the decision timeline, and your rights after a denial.
From U.S. Department of Labor, Employee Benefits Security Administration
- Program or service
Form 5500 search: look up your employer plan's annual report
A Department of Labor search of the annual reports (Form 5500) that many employer plans file. A search can help you work out whether your employer plan is insured or pays claims itself.
From U.S. Department of Labor, EFAST2 filing system
- Program or service
Health Insurance Portability and Accountability Act right of access to your health information
The federal guidance on your right to see and get copies of your records held by your health plan and most providers, and to have them sent to someone you name.
From U.S. Department of Health and Human Services
- Program or service
HealthCare.gov: how to appeal a health plan decision
The federal explanation of the two steps for a denied claim or cancelled coverage: an internal appeal with your plan, then external review by an independent third party.
From HealthCare.gov (Centers for Medicare & Medicaid Services)
- Program or service
Indian Health Service Purchased/Referred Care: appeal a denial
How American Indian and Alaska Native patients ask the Indian Health Service to reconsider a denial of payment for care received away from an Indian Health Service or tribal facility.
From Indian Health Service
- Program or service
Medicaid fair hearings: federal explainer
A federal fact sheet on the right to a Medicaid fair hearing when a state denies, reduces or ends your Medicaid benefits, with hearing rights, deadlines that vary by state, and how benefits can continue.
From Centers for Medicare & Medicaid Services, Medicaid.gov
- Program or service
Medical Bill Rights: find an action plan for your medical bill
A five-minute federal questionnaire about your billing problem that gives you suggested next steps, whether you already have a bill or are planning for care.
From Centers for Medicare & Medicaid Services
- Program or service
Medicare Beneficiary Ombudsman
A federal office that helps with Medicare complaints and information requests that your plan or 1-800-MEDICARE has not resolved. You reach it by asking a 1-800-MEDICARE representative to send it on.
From Centers for Medicare & Medicaid Services
- Program or service
Medicare.gov: filing an appeal
The official Medicare page on appealing a coverage or payment decision, with separate instructions for Original Medicare, Medicare health plans and drug plans, plus fast appeals when services end too soon.
From Medicare.gov (Centers for Medicare & Medicaid Services)
- Program or service
No Surprises Help Desk: surprise bill questions and complaints
The federal help desk for questions or complaints that a plan, provider or facility broke the surprise billing rules. It reviews the complaint and may refer it to another federal or state enforcer.
From Centers for Medicare & Medicaid Services
- Program or service
Office of Personnel Management: disputed claims for federal employee health plans
The Office of Personnel Management (OPM) reviews a denied claim from a federal employee health plan after the plan has reconsidered it. This page explains the order, how to write to OPM, and the response times it states.
From U.S. Office of Personnel Management
- Program or service
State Health Insurance Assistance Program locator (shiphelp.org)
The national site for finding your local State Health Insurance Assistance Program (SHIP), which gives free, one-on-one Medicare counseling, including help with complaints and appeals.
From SHIP National Technical Assistance Center
- Program or service
TRICARE appeals
The official TRICARE page on the four kinds of appeal (factual, medical necessity, pharmacy, and Medicare-TRICARE), with mailing addresses for each regional contractor and the Defense Health Agency.
From TRICARE (Defense Health Agency)
- Program or service
Veterans Affairs clinical appeals and decision reviews
How a veteran asks Veterans Affairs (VA) to review a treatment decision (a clinical appeal) or a decision about a VA benefit, including health care benefits, with the review options and what to send.
From U.S. Department of Veterans Affairs
- Program or service
Veterans Affairs patient advocate program
Every VA medical facility has a patient advocate who handles concerns from veterans and families. The advocate can help with a care problem and, if needed, help you file an appeal.
From U.S. Department of Veterans Affairs, Veterans Health Administration
State agencies and advocates
12 12 programs
12
- Program or service
California Department of Managed Health Care: Independent Medical Review
California's regulator for managed care plans reviews denials of medical services, emergency payment and experimental treatment through Independent Medical Review. One form starts either a review or a consumer complaint.
From California Department of Managed Health Care
- Program or service
California Independent Medical Review decision search
A searchable database of every California Independent Medical Review decision since 1 January 2001. Search by drug, treatment, therapy or condition to read how reviewers decided cases like yours.
From California Department of Managed Health Care
- Program or service
Connecticut Office of the Healthcare Advocate
A free Connecticut state office that helps residents understand their benefits and speaks up for them when a claim or a prior authorization request (advance approval for care) is denied. Open to people with any kind of coverage.
From State of Connecticut, Office of the Healthcare Advocate
- Program or service
Maryland Attorney General: Health Education and Advocacy Unit
A free Maryland mediation service that helps with denied coverage from private health plans, plan terminations, surprise bills, hospital financial assistance and billing disputes.
From Office of the Attorney General of Maryland, Consumer Protection Division
- Program or service
Maryland Insurance Administration: appeals and grievances
Maryland's insurance regulator explains the state appeals and grievances law: you first use your plan's own grievance process, then you can ask the Insurance Administration to review a denial of medically necessary treatment.
From Maryland Insurance Administration
- Program or service
Massachusetts Office of Patient Protection: external review
Massachusetts runs independent review of health plan decisions based on medical necessity. You have 4 months from your plan's final denial letter to ask, and an eligible request gets a final and binding decision.
From Massachusetts Health Policy Commission, Office of Patient Protection
- Program or service
New York Department of Financial Services: external appeal
If a New York insurer or health maintenance organization denies care as not medically necessary, experimental or out of network, you can ask the state for an external appeal. You have 4 months from the plan's final decision.
From New York State Department of Financial Services
- Program or service
New York external appeals searchable archive
A database of closed New York external appeals decided on or after 31 May 2019. Filter by diagnosis, treatment, health plan, decision and year to see outcomes of similar cases.
From New York State Department of Financial Services
- Program or service
Smart NC: health claim denied (North Carolina)
A North Carolina Department of Insurance program that helps consumers resolve coverage disputes with their health insurance company. The page says there is no cost for its services.
From North Carolina Department of Insurance, Smart NC
- Program or service
Texas Department of Insurance: appeal, external review and complaints
The Texas Department of Insurance explains how to appeal a denied treatment, ask for an independent external review and file a complaint. It helps with fully insured plans and cannot overturn a reviewer's decision.
From Texas Department of Insurance
- Program or service
Washington independent review decision search
A state search of independent review decisions Washington has collected since 2016. Results show the insurer, diagnosis and treatment, the outcome and the reviewer's reasoning.
From Washington State Office of the Insurance Commissioner
- Program or service
Washington Insurance Commissioner: appealing a health insurance denial
Washington's insurance regulator explains how to appeal a denial, which plans it regulates, and where to find sample appeal letters by denial reason. Consumer advocates answer questions and take complaints.
From Washington State Office of the Insurance Commissioner
Nonprofits and patient groups
20 20 programs
20
- Program or service
American Cancer Society 24-hour helpline
A phone and chat line staffed around the clock by cancer information specialists who answer questions and connect you to services. It is an information and referral line, not an appeals service.
From American Cancer Society
- Program or service
Arthritis Foundation Rx for Access insurance toolkit
A multi-page toolkit and a helpline for people with arthritis covering claims, common denial reasons, explanation of benefits, and appeals for private and government plans. Condition-specific: arthritis, including juvenile arthritis.
From Arthritis Foundation
- Program or service
Center for Medicare Advocacy self-help materials
Downloadable self-help toolkits for Medicare denials involving home health care, outpatient therapy and skilled nursing facility care, from a nonprofit law organization. The page describes materials, not a helpline.
From Center for Medicare Advocacy
- Program or service
Community Health Advocates (New York)
New York State's designated consumer assistance program: a free helpline and local advocates for New Yorkers with any kind of coverage, plus do-it-yourself appeal guides. Open to New York residents only.
From Community Service Society of New York
- Program or service
Coverage Rights state-by-state appeal steps
A nonprofit website that gives each state's steps for appeal, external review and complaint when an insurer denies or delays a treatment, with a focus on medicines. No helpline or letters.
From Aimed Alliance
- Program or service
Crohn's & Colitis Foundation appeal letter library
Customizable appeal letters for Crohn's disease and ulcerative colitis treatments, tests and dose changes, including a request to use a biologic without first failing other drugs. Written for the doctor's office to edit.
From Crohn's & Colitis Foundation
- Program or service
Dollar For hospital financial assistance help
A free nonprofit service that helps you apply to a hospital for financial assistance (also called charity care) that can reduce or erase a hospital bill. It is about hospital bills, not insurance denials.
From Dollar For
- Program or service
FAIR Health Consumer cost estimates
A nonprofit's tools for estimating what providers charge and what insurers pay in your area, plus insurance basics. Useful evidence in an out-of-network payment dispute. It does not file appeals or negotiate for you.
From FAIR Health
- Program or service
Immune Deficiency Foundation insurance appeals
Guidance on appealing a denied claim or filing a complaint, aimed at people with primary immunodeficiency, with advice on peer-to-peer review and letters of medical necessity. Condition-specific: especially immunoglobulin therapy.
From Immune Deficiency Foundation
- Program or service
Medicare Interactive: Medicare appeals
Free plain-language guides to appealing a Medicare denial, split by Original Medicare, Medicare Advantage and Part D drug coverage, from the Medicare Rights Center. Covers Medicare only.
From Medicare Rights Center
- Program or service
Medicare Rights Center national helpline
Free phone counseling for people with Medicare, their families and caregivers on benefits, denials and appeals, and cost-saving programs. Spanish is available. It covers Medicare only.
From Medicare Rights Center
- Program or service
National Alliance on Mental Illness guide to insurance denials
A plain explanation of why mental health care is denied, five signs of a possible parity violation, and a link to a longer appeals guide written with The Kennedy Forum. Information only.
From National Alliance on Mental Illness
- Program or service
National Alliance on Mental Illness HelpLine
A free, confidential helpline for mental health information, support and resources. It does not do individual advocacy or casework, so it will not fight a denial for you. In a crisis, call or text 988.
From National Alliance on Mental Illness
- Program or service
National Association of Insurance Commissioners: find your state insurance department
A national directory where you pick your state or territory to find its insurance department, get contact details and start a complaint. Useful for plans bought from an insurance company.
From National Association of Insurance Commissioners
- Program or service
National Organization for Rare Disorders patient assistance
Financial help for people with certain rare diseases with medicines, insurance premiums, co-pays, testing and travel, plus a patient services line. It is financial help, not an appeals service. Condition-specific.
From National Organization for Rare Disorders
- Program or service
Parity Registry appeal support for mental health and addiction care
A step-by-step guide to fighting a denial of mental health, eating disorder or addiction care under the federal parity law, with a complaint registry and a place to share your story. It does not file appeals for you.
From The Kennedy Forum
- Program or service
Patient Advocate Foundation appeals guide and sample letters
A free 10-page guide to appealing a health plan denial, with a fill-in-the-blank appeal letter, from a patient-advocacy charity. It is written for most private plans and does not give your own deadlines.
From Patient Advocate Foundation
- Program or service
Patient Advocate Foundation case management
Free one-on-one help from a case manager who can work on insurance denials and prior authorizations for patients with a serious or chronic condition who meet the program's rules. Intake is by phone and new cases are limited each day.
From Patient Advocate Foundation
- Program or service
Triage Cancer legal and financial navigation
Free one-on-one phone help with health insurance, disability insurance, work and money questions from a cancer-focused legal-education nonprofit. It gives information, not legal representation or financial aid.
From Triage Cancer
- Program or service
Triage Cancer state-by-state health insurance appeals toolkit
Free downloadable toolkit with general appeals guidance plus a section and forms for each state. Made by a cancer-focused legal-education nonprofit, but the page describes it as for people using health insurance and challenging denials.
From Triage Cancer
Legal aid
9 9 programs
9
- Program or service
Cancer Legal Resource Center and Cancer Justice helpline
A legal helpline and resource library for people with cancer, run by the Disability Rights Legal Center. Covers legal questions about insurance, work and money. Whether staff can take your case is not stated.
From Disability Rights Legal Center
- Program or service
Disability Rights Florida guide to Medicaid fair hearings
A step-by-step explanation of how to challenge a denial or reduction of Medicaid services in Florida, from notice to petition to hearing. For people with disabilities. Florida only.
From Disability Rights Florida
- Program or service
Health Consumer Alliance (California)
A statewide partnership of legal aid organizations offering free help by phone or in person to Californians with Medi-Cal, Covered California or private coverage, including disputing denials and billing problems.
From Health Consumer Alliance
- Program or service
LawHelp.org free legal information and legal aid finder
A site that points you to free legal information and nonprofit legal aid providers in your state. It is a starting point for finding a program; it does not appeal a denial for you.
From LawHelp.org
- Program or service
Legal Action Center free legal help in New York
Free legal help for New Yorkers with substance use disorders or mental health care needs, including insurance barriers to treatment. Nationwide help is limited to certain addiction-medication cases.
From Legal Action Center
- Program or service
Legal Services Corporation: find free legal aid
A search page that finds a civil legal aid organization near you. These organizations serve low-income people; the page does not say whether a local program takes health insurance cases.
From Legal Services Corporation
- Program or service
Legal Services Corporation: find legal aid near you
A search by address or city for civil legal aid organizations funded by the Legal Services Corporation, which supports free legal help for low-income Americans, with a link to LawHelp.org for information and forms.
From Legal Services Corporation
- Program or service
National Disability Rights Network: find your state agency
A directory of the federally mandated Protection and Advocacy agencies, one in every state and territory, that provide legal advocacy for people with disabilities, including difficulty getting disability services.
From National Disability Rights Network
- Program or service
Vermont Office of the Health Care Advocate (VTLawHelp)
A free helpline for Vermonters with health care and health insurance problems, run as a project of Vermont Legal Aid. Its website also has plain-language pages on appeals, grouped by the kind of coverage you have.
From Office of the Health Care Advocate, a project of Vermont Legal Aid
Journalism and research
4 4 programs
4
- Program or service
An Arm and a Leg: First Aid Kit
An archive of articles and starter packs from the podcast An Arm and a Leg, including a starter pack on what to do if you are in collections for medical debt. General reporting on health care costs, not appeal steps.
From An Arm and a Leg
- Program or service
KFF analysis: claims denials and appeals in marketplace plans in 2024
KFF's analysis of federal data on claims denied and appealed in HealthCare.gov plans in 2024. It reports that 19% of in-network claims were denied. It is a source of statistics, not a how-to guide.
From KFF
- Program or service
KFF Health News: seven tips for fighting a health insurance denial
A news article with seven tips for fighting a prior authorization denial, including knowing your plan type, working with your provider, staying organized, and asking for help. Written by a reporter, not by an agency.
From KFF Health News
- Program or service
ProPublica Claim File Helper
A free tool from ProPublica that builds a letter asking your health insurer for your claim file: the notes, call recordings and records it used to deny you. Request it before you appeal.
From ProPublica
Commercial services (paid or for-profit)
7 7 programs
7
- Program or service
AppealArmor
A free web tool that reads a photo or text of your denial letter, shows you what it read, and emails an appeal letter and a Next Steps sheet with where to send it and your deadline. It also has a deadline calculator.
From AppealArmor
- Program or service
Claimable
A paid service that builds an appeal for specific denied medicines and mails and faxes it for you. It lists about 85 medicines and does not cover other kinds of denial. Price is shown after you start.
From Claimable, Inc.
- Program or service
Counterforce Health
A free artificial intelligence (AI) appeal letter generator for individuals, plus a large blog of drug, insurer and state guides. The tool sits behind an intake form and an email account.
From Counterforce Health, Inc.
- Program or service
Fight Health Insurance
A free tool that uses artificial intelligence (AI) to draft appeal letters from a photo or text of your denial letter. It also has a denial explainer, glossary and state help pages. Run by a company, not a nonprofit or law firm.
From Fight Health Insurance, Inc.
- Program or service
Health Appeal
A free service with an in-page deadline check and an appeal letter builder that works inside an artificial intelligence (AI) assistant or on its site. You sign and send the letter yourself.
From Health Appeal
- Program or service
Persius: denial support
An organization that says it helps people fight inappropriate coverage denials for free, using artificial intelligence (AI) with human review. It also does research on denials.
From Persius
- Program or service
Sheer Health
A paid membership service that connects to your insurance account, watches claims and, on paid tiers, handles denials and appeals for you, including calls to insurers. It does not teach you to appeal yourself.
From Sheer Health, Inc.
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