Free Health Insurance Appeal Letter Template

Copy it, fill in the brackets, and send it to your insurer today.

If your health insurer denied a claim, you have the right to a formal internal appeal. This free template covers the elements insurers and regulators expect to see in a first-level appeal letter: your claim details, the insurer's stated denial reason, your explanation of why it's wrong, and the supporting documents to attach.

What's in the Template

A full letter you can copy: member and claim identifiers, a section to quote the denial reason back to the insurer, your explanation, a documentation checklist, and a request for written confirmation of receipt and next steps.

Filing Deadlines

Internal appeals for employer and ACA marketplace plans commonly must be filed within 180 days of the denial notice — check your plan documents or Explanation of Benefits for your exact window, since it varies by plan type (ERISA, ACA, Medicare Advantage, Medicaid).

Want It Done for You?

Medigami's $149 Bill Rescue service reviews your bill and denial, and drafts the appeal for you — done in 48 hours. You review, sign, and submit it yourself.

Educational free template only. Not legal or medical advice. Consult a licensed attorney or state-certified insurance counselor about your specific situation.


Loading Medigami...