Part of: Understand your denial

Step 1 of 3 in the journey

A denial is a first answer.
Find out exactly what it says.

Before you write anything, get four facts straight: what was refused, the reason given, what kind of coverage you have, and your deadline. Everything else follows from those.

Holding a letter you do not understand? Start here.

Tools for this step

6 tools

Free, no account, nothing leaves your browser.

  • Coverage type finder

    Work out what kind of plan you have and who regulates it, even if you are not sure.

    Tool

  • Deadline calculator

    Turn the date on your notice into the dates you and the plan each have to meet, with the rule behind each one.

    Tool

  • Denial letter checker

    Tick what your denial letter contains and see what is missing and how to demand it.

    Tool

  • Denial reason finder

    Match the wording on your letter to a denial reason, see who must act first, and open the right playbook.

    Tool

  • Explanation of Benefits decoder

    Look up the lines and common codes on your statement and see whether you should pay yet.

    Tool

  • Start here: four questions

    Answer four questions about what you received and get your path, the general deadline for your coverage and your first steps, with the phone call to make first if care is ending.

    Tool

Start with

16 guides

16 guides in this area

  • Guide

    How to read a denial letter line by line

    Find the reason, the rule the plan relied on, your appeal rights and your deadline in a denial letter. Read them in the order that makes the letter easiest to act on.

  • Guide

    The first 48 hours after a denial

    A calm list of what to do, and what to hold off on, in the first two days after a health plan says no to care, a drug or a claim.

  • Guide

    What a denial letter must tell you

    A federal rule lists what a denial notice from an employer plan or an insurance company must contain. Here is the exact list, and what to do when something is missing.

Letters, checklists and programs

5 items
  • First 48 hours after a denial

    What to do, and what to leave alone, in the first two days after you get a denial, before you write an appeal.

    Checklist

  • What your denial letter should contain

    A list of what the federal rules say a denial notice must contain, so you can tick what your letter has and ask for what it lacks.

    Checklist

  • Ask for a denial in writing

    A written request for a proper denial notice when the plan has only told you by phone that it will not approve or pay. It lists what the notice must contain so you know your reason and your appeal rights.

    Letter or script

  • Phone script: first call after a denial

    What to say and ask on your first call to your plan after a denial, and what to write down before you hang up.

    Letter or script

Programs and services 1

Run by other organizations. We summarize them and say when we last checked.

  • 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

Your next step may connect

  • Build your case

    Collect the file, the records, your doctor's support and the plan's own rules, then write it up.

  • Your coverage

    The appeal steps, deadlines and regulators for your kind of plan, from employer plans to Medicare and Medicaid.