Appeals are won on paper.
Gather it before you write.

Ask the provider for every charge on your account, then compare it with your Explanation of Benefits to find errors. Covers the billing-records right you do have and the itemized-bill right the federal rules do not give.

Make it easy for your doctor's office to write a letter that answers the plan's reason for denying your care. Covers who to ask, what to hand over, when, and what to do if the office says no.

Put your appeal letter, your doctor's letter, records and plan documents in order, then send the packet so you can prove the plan received it. Includes a check of what to enclose and what to keep.

Work with your doctor to find the guidelines and studies that back your treatment, and use them to answer the plan's reason. Covers experimental denials, past review decisions and how to cite evidence.

Ask for the clinical rule your plan used to deny your care, find out which version applied, and check it against your records. Covers what a denial notice must say and what you can request for free.

Ask your doctor, hospital or clinic in writing for a copy of your own records for your appeal. Covers what the federal health privacy rule says about timing and fees, and which records an appeal needs.

Record every call, letter and message with your plan and providers, with names, dates and reference numbers, so you can prove what was said and keep your deadlines straight. Includes a simple log you can copy.

Call habits that protect you, such as getting names and reference numbers and asking for it in writing, and what a phone call can and cannot do. Links to phone scripts for common calls after a denial.

A plain structure for your appeal letter, from what you want to a request for a written decision. Includes what to put in each part, what to leave out, and links to letters for each denial reason.

A peer-to-peer review is a phone call between your doctor and the plan's reviewing doctor. It is usually worth asking for early, but availability and timing vary by plan. Here is how to ask and prepare.

Quote the plan's own definitions, exclusions and criteria back to it in your appeal. Covers where to find them, how to quote them accurately, and what to do when the plan's documents work against you.

A checklist for the letter your doctor writes, so it answers the plan's stated reason, uses the plan's own criteria, and gives the reviewer the facts needed to decide. For you to check the draft against.

How to write a short, honest account of what your condition and the denial have done to your health and daily life, to sit beside your doctor's letter in an appeal. Includes prompts and what to leave out.