How to Appeal a Denied Medical Bill

A step-by-step framework that works across all major insurers

Roughly one in five medical claims are denied on first submission. Most denials can be overturned — many appeals result in partial or full reversal when properly documented (KFF 2023 ACA marketplace aggregate: ~40% external-review reversal rate). This guide is the universal framework; for insurer-specific tactics see our Aetna, UnitedHealthcare, Cigna, BCBS, and Anthem appeal guides.

The Five-Step Appeal Process

  1. Request the full denial reason in writing. Insurers must provide specific denial codes on your EOB.
  2. Gather clinical documentation. Get the ordering physician's notes explaining medical necessity.
  3. Submit an internal appeal. File within your insurer's deadline (usually 180 days) with a cover letter, supporting records, and any relevant clinical guidelines.
  4. Escalate to external review. If the internal appeal fails, request an Independent External Review — federal law requires insurers to comply with the reviewer's decision.
  5. File a state complaint. Your state Department of Insurance can investigate bad-faith denials.

Appeal Deadlines by Claim Type

Standard post-service claim: Insurer must respond within 30 days of internal appeal submission. Pre-service claim: 30 days. Urgent/concurrent care: 72 hours. Missing your appeal window (typically 180 days from denial) forfeits your rights entirely.

How Medigami Helps

Upload your denial letter or EOB and Medigami generates an appeal letter citing the applicable clinical policy, tracks your deadlines, and escalates to external review if the internal appeal fails. Free, no signup required.

Educational information only. Not legal, medical, or insurance advice. Statutes, deadlines, and eligibility thresholds vary by plan type and state — consult a licensed attorney, state-certified insurance counselor, or nonprofit patient advocate about your specific situation.

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