1 in 5 Health Insurance Claims Are Denied — But Less Than 1% Are Appealed. Here’s Why That Matters
Every year, millions of Americans submit health insurance claims expecting their plans to cover essential care — from surgeries to prescriptions and hospital stays. Yet according to the Kaiser Family Foundation, nearly 1 in 5 in-network claims are denied by health insurers.
Even more shocking: fewer than 1% of denied claims are ever appealed.
If you’ve received a denial letter, you’re not alone — and you’re not stuck. Understanding how to file a health insurance appeal can mean the difference between paying thousands out of pocket and getting the coverage you deserve.
Why Health Insurance Claims Get Denied
Insurers deny claims for many reasons — some legitimate, others preventable. Here are the most common ones:
Missing or incorrect information (billing codes, dates, or provider details)
Out-of-network care or providers not covered by your plan
Medical necessity disputes, where the insurer claims treatment wasn’t required
Experimental or investigational procedures that your plan doesn’t cover
Clerical or coding errors from providers or insurers
The good news? Most of these denials can be reversed with a properly structured insurance appeal template and supporting evidence.
The Cost of Not Appealing
When patients don’t appeal denied claims, they often face staggering medical bills. But beyond the financial hit, failing to appeal lets insurers set the rules unchallenged. Federal law gives you the right to appeal any denied claim — first through an internal review, and then, if needed, an external review by an independent organization. Studies show that 40–60% of appealed denials get overturned, meaning millions of Americans could have their care covered if they simply appealed.
Why Most People Don’t Know They Can Appeal a Denied Insurance Claim
When a health insurance company denies a claim, most people accept it as final — not because they agree, but because they don’t realize they have the power to fight back. The truth is, every policyholder has the legal right to appeal a denied insurance claim, but millions never do. Here’s why.
Insurance Companies Don’t Emphasize Your Right to Appeal
While federal law requires insurers to include appeal instructions, they don’t have to make those rights obvious or easy to use. Denial notices usually bury this information at the bottom of the page or in small print, instead of clearly saying:
“You have the right to appeal this decision, and here’s how.”
As a result, many people never notice their appeal rights at all — or they miss critical deadlines because they didn’t understand how fast they needed to act. Many people think an insurer’s denial is final. In reality, every denial letter must include instructions for appeal — though these are often buried in complex legal wording.
Denial Letters Are Confusing by Design
When insurers deny a claim, they’re required by law to explain why. However, most denial letters are filled with technical insurance terms and legal language that make it nearly impossible for the average person to understand.
Instead of saying, “You can appeal this decision,” the letter often includes phrases like:
“You may request a review pursuant to Section 2719 of the Public Health Service Act within 180 days of this notification.”
For someone not familiar with insurance jargon, that’s intimidating. Many people assume the decision is final — when in reality, it’s only the first step in a process they’re entitled to challenge.
People Are Overwhelmed or Unwell When Denials Happen
Insurance denials often come during stressful or vulnerable times — following surgery, hospitalization, or treatment for serious illness. Filing an appeal can feel daunting. The process involves:
Understanding why your claim was denied
Gathering medical records and provider statements
Writing a persuasive medical necessity appeal letter
Submitting the appeal correctly and on time
When someone is sick, recovering, or caring for a loved one, researching how to appeal an insurance denial is understandably low on their list. They may feel defeated, assume there’s no point in fighting, or simply lack the energy to deal with paperwork. Without guidance, most people give up before they start. That’s why ready-made insurance appeal templates and step-by-step instructions can make all the difference — they simplify the process and remove the fear factor.
People Trust Their Insurers Too Much
Many consumers believe that if their insurance company denied a claim, it must have been for a valid reason. But data shows that’s not always true. In 2023, insurers on the federal ACA marketplace denied nearly 20% of in-network claims, and many of those denials were based on clerical errors, incomplete documentation, or questionable interpretations of “medical necessity.” In other words, denials happen not because care was inappropriate, but because paperwork or coding wasn’t perfect — problems that are often fixable through appeal.
Time Limits Are Short
Appeal deadlines can be as brief as 30 days. Many people miss these windows because they don’t understand what’s required or assume the process isn’t worth the effort.
There’s a Lack of Public Awareness and Education
Most Americans don’t receive education about their health insurance rights. Even though every plan must offer an internal and external appeal process, this information rarely reaches policyholders in a clear way. Unlike credit scores or taxes, health insurance navigation isn’t taught in schools, and many people only learn about appeals after a denial — when time and stress are already high. Hospitals and clinics rarely have the resources to help patients craft appeal letters, leaving individuals to figure it out alone.
Many Don’t Realize How Often Appeals Succeed
If more people knew that 40–60% of appeals are approved, they’d be far more likely to file one. Most appeals that win do so because the patient submitted missing documentation or clarified that a treatment was medically necessary. That means appealing isn’t just possible — it’s often effective.
Why Appealing Matters
Appealing your denial isn’t just about your bill — it’s about fairness and accountability. Every successful appeal forces insurers to justify their decisions and improve coverage standards. Your action today can help shape how insurers handle future claims, potentially improving access to care for thousands of others.
How to Appeal an Insurance Denial (Step-by-Step)
Here’s exactly how to appeal a health insurance denial effectively:
Step 1: Review the Denial Letter
Look for:
The reason for the denial
The deadline for filing an appeal
Instructions for submitting your appeal
Identify the denial category — “medical necessity,” “experimental treatment,” or “out-of-network.” This tells you what evidence you need.
Step 2: Gather Documentation
Collect all relevant records:
Doctor’s notes and test results
Letters of medical necessity from your provider
Copies of bills and correspondence
If your claim was denied due to “medical necessity,” ask your physician to write a medical necessity appeal letter that clearly explains why the treatment is essential.
Step 3: Write a Strong Appeal Letter
Use a professional insurance appeal template to make sure you include:
Your policy number and claim ID
A clear explanation of the denial
Supporting medical and factual evidence
References to your plan’s terms or clinical guidelines
A strong, organized letter demonstrates credibility and significantly increases your chances of success.
Step 4: Submit Your Appeal and Track It
Send your appeal via certified mail or your insurer’s portal and keep all proof of submission. If the internal appeal fails, you can request an external review, which often results in a reversal.
In my FREE Appeal Guide, I am sharing legal tips on how to submit a winning appeal.
How Appeal Templates Helps You Win
At Appeal Templates, we make the process simple and stress-free.
Our ready-to-use templates are professionally written to help you craft a clear, persuasive health insurance appeal — whether your denial is for medical necessity, experimental treatment, or out-of-network care.
You’ll find:
Customizable insurance appeal templates for all major denial reasons
Sample appeal letters for various denials such as medical necessity, out of network, prior authorization, etc. written by an attorney
Step-by-step guides for denied insurance claim help
Each document is easy to edit, legally sound, and designed to help you take confident action.
Real-World Results
People who appeal are often amazed by the results:
Denied surgeries and treatments get approved
Out-of-network care is reimbursed
Thousands of dollars are recovered
Even if your first appeal doesn’t succeed, persistence pays. Many people win on their second or external appeal after clarifying details or submitting stronger medical evidence.
Millions of denied claims go unchallenged every year, not because people can’t win, but because they don’t know they can try.
Health insurance companies count on this confusion. They know that the fewer people who appeal, the more money they save. But you have a right to challenge their decision — and you have tools that make it simple.
At AppealTemplates.com, we provide denied insurance claim help with clear, customizable insurance appeal templates. You don’t need to be an expert or a lawyer — you just need to know your rights and take the first step.
Your claim deserves a fair review. Your health deserves coverage. And your voice deserves to be heard.
If your claim was denied, don’t wait. Visit AppealTemplates.com to download a customizable medical necessity appeal letter or insurance appeal template. Get attorney-crafted denied insurance claim appeal letters and learn exactly how to appeal an insurance denial the right way — quickly, confidently, and effectively. Take control of your coverage and get the healthcare benefits you’ve earned.
