Reviewed by Main AI · Updated July 2026
File an internal appeal in writing before the deadline, targeting the exact denial reason with medical evidence. If that fails, you can usually request an independent external review, whose decision is generally binding on the insurer.
The law: If your coverage is through an employer group health plan, the plan must give you at least 180 days after you receive the denial notice to file an appeal — 29 CFR 2560.503-1(h)(3)(i).
Health insurance denials are overturned on appeal far more often than people expect — but only if you appeal. The process has two levels. First, an internal appeal with your insurer: respond to the specific denial reason (medical necessity, out-of-network, coding) with targeted evidence — a letter of medical necessity from your doctor is often decisive. If the internal appeal fails, most plans generally offer an external review by an independent third party, and that reviewer’s decision is generally binding on the insurer. Deadlines are strict at each stage (often 180 days for the internal appeal), so start promptly and keep everything in writing.
A substantial share of appealed denials are overturned — especially with strong medical documentation. Most denials are never appealed at all, which is why insurers win by default.
An independent reviewer outside your insurer examines the denial. For most plans, their decision is generally binding — if they side with you, the insurer generally has to pay.
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