Appeal Tips & Resources
You've got your appeal letter. Now what? Follow these expert tips to maximize your chances of success.
50%+
Appeals succeed
30-180
Days to appeal
2-3x
Better odds with lawyer
1After Sending Your Appeal Letter
📝 Document Everything
Keep copies of your appeal letter, any evidence you submitted, and the certified mail receipt with tracking number. Take photos before mailing.
📅 Mark Your Calendar
Insurance companies typically have 30-60 days to respond to appeals. Set a reminder. If they miss the deadline, they may be in violation of state regulations.
📞 Follow Up
Call after 2 weeks to confirm receipt. Get the name of whoever you speak with and note the date/time. Ask for a case number if you don't have one.
2If Your Appeal Is Denied
Don't give up! A first-level denial is not the end. You have options.
🔄 Internal Appeal (Level 2)
Most insurance policies allow for a second internal appeal. This time, include:
- Additional medical records or evidence
- A letter from your doctor explaining medical necessity
- Peer-reviewed studies supporting your treatment
⚖️ External Review
For health insurance, you have the right to an Independent External Review by a third party not connected to your insurer. This is often free and binding.
🏛️ State Insurance Commissioner
File a complaint with your state's Department of Insurance. They can investigate and sometimes force action. Find your state's office →
3When to Hire a Lawyer
Consider Legal Help If:
Your claim is over $10,000
You've been denied twice already
The insurer is acting in bad faith
It involves serious injury or disability
You're dealing with ERISA/employer plans
Deadlines are approaching fast
💡 Good News: Many Work on Contingency
Most insurance appeal lawyers work on contingency — meaning they only get paid if you win. Typical fee is 25-40% of the recovered amount. Many offer free consultations to evaluate your case.
4Common Mistakes to Avoid
❌ Missing deadlines
Appeals have strict time limits. Mark them in your calendar.
❌ Being too emotional
Stick to facts and policy language. Anger doesn't help.
❌ Not getting it in writing
Phone promises mean nothing. Always follow up in writing.
❌ Accepting verbal denials
Demand a written denial with specific reasons cited.
❌ Giving up too soon
Many claims win on 2nd or 3rd appeal. Persistence pays.
❌ Not reading your policy
The key to winning is in the policy language. Read it.
5Helpful Resources
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