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Insurance Claim Appeal Letter
Your insurer denied a claim or prior authorization, and the only thing standing between you and a reversal is a letter that addresses their stated reason directly. Around 40 to 54 percent of properly documented appeals are overturned, but most people never file one because the letter feels too hard to write. LetterLotus turns your denial notice and the facts of your case into a focused, professional appeal you can send today.
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Writing assistance tool · Not legal advice. LetterLotus is not a law firm and does not provide legal advice. No attorney-client relationship is created by using this tool.
Your letter
- MRI denied as not medically necessary
- six weeks of failed physical therapy
- Dr. Patel ordered it on April 3
written into
You denied prior authorization for my daughter's MRI because conservative treatment had not been attempted. Dr. Patel's notes document six weeks of it, January to March.
I am appealing the denial and asking you to approve the authorization. Dr. Patel's notes are enclosed.
Balanced & Thorough
How It Works
Pick your favorite draft
We generate 4 different versions of your letter, each with a different tone. You pick the one that sounds most like you.
Edit, download & use
Make any edits you want, then download a print-ready PDF or Word document. It's your letter.
What Your Insurance Appeal Covers
- The specific denial you are appealing and the insurer's stated reason
- The facts of the underlying claim, treatment, or loss
- Why the denial is wrong, grounded in policy language and your evidence
- A clear, actionable request for the outcome you want
- A list of attachments the appeals reviewer should consider
Frequently Asked Questions
What kinds of denials can this letter handle?
Health insurance denials of all kinds — denied claims, denied prior authorization, denied medical necessity, denied as experimental or investigational, out-of-network denials, formulary or step-therapy denials — as well as denied or undervalued auto and homeowners property claims. The structure of an internal appeal is the same: address the insurer's stated reason, cite the policy, attach the evidence, ask for the specific outcome.
What is the difference between an internal appeal and an external review?
An internal appeal is a request to your insurer to reconsider its own decision through its internal appeals unit. Under the Affordable Care Act, most non-grandfathered health plans must offer this and decide within 30 days for pre-service claims (72 hours if urgent) and 60 days for post-service claims. An external review is the next step if the internal appeal is denied: an independent reviewer with no relationship to your insurer takes a fresh look, and their decision is binding on the insurer. This tool helps you write the internal appeal — the first formal step.
How long is the appeal deadline?
For ACA-governed health plans and most ERISA employer plans, you have 180 days from the date of the denial notice to file an internal appeal. Auto and homeowners deadlines are set by state law and by the policy itself, and typically range from 30 to 90 days. Check the denial notice — insurers are required to print the deadline on it.
Do I need a letter from my doctor?
For health insurance denials based on medical necessity, a letter of medical necessity from your treating provider is the single highest-value attachment you can include. It does not have to be long — it needs to address the insurer's specific denial reason with clinical detail. Ask your provider's office; many doctors' offices write these regularly. Your appeal letter then references it.
Should I threaten to sue or to complain to the state?
No. A clear, factual appeal that argues the policy and the facts gets read on the merits. Legal threats tend to get the letter routed to the insurer's legal department, where it sits in a queue. If your internal appeal is denied, an external review (binding) or a complaint to your state's department of insurance are the next channels — and at that point, it is reasonable to consult an attorney.
What if my plan is self-funded by my employer?
Self-funded employer health plans are governed by ERISA, which gives you the right to request the complete administrative record of documents the insurer used to deny your claim. Submitting that request before or alongside your appeal is a strong move. If the appeal is denied, ERISA litigation has specific rules and short timelines — at that stage, consult a licensed ERISA attorney.
Is this legal advice?
No. This tool helps you draft a clear letter to your insurer's appeals department using the facts and policy language you provide. It does not interpret the law, evaluate the merits of your case, or guarantee any outcome. For complex denials, suspected bad-faith handling, large dollar losses, or ERISA litigation, consult a licensed attorney or your state's department of insurance.
How much does this cost?
$39, one time. No subscription, no hidden fees. You get PDF, Word, and clipboard formats, plus inline editing and unlimited re-downloads.
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Important: LetterLotus provides a letter you write and send yourself. We are not a law firm or a licensed insurance adjuster, and this is not legal or insurance advice.
Ready to Write Your Letter?
Appeal deadlines are short, often 180 days for health plans and 30 to 90 days for auto and homeowners. Start your appeal now so the deadline doesn't decide the outcome for you.
Writing assistance tool. Not a law firm. Not legal advice.