Denied by Insurance? Choose the Right Appeal Letter Template

If your health insurance claim was denied, you are not alone — and you are not out of options.

Insurance companies deny millions of claims every year, often for technical reasons that have little to do with whether your care was appropriate. What matters now is how you respond.

The fastest way to fix a denial is to submit the right appeal, written for the specific reason your claim was denied.

This page will help you:

• Identify your denial type

• Choose the correct attorney-written appeal template

• Avoid mistakes that permanently lock in a denial

First: Find the Exact Reason Your Claim Was Denied

Look at your denial letter or Explanation of Benefits (EOB).
Most denials fall into one of these categories:

• “Not medically necessary”

• “Out-of-network”

• “Prior authorization required”

• “Not covered by the policy” / “Policy exclusion”

• “Experimental or investigational”

👉 The appeal strategy is different for each one.
Using the wrong appeal approach is one of the main reasons appeals fail.

Why Most People Lose Insurance Appeals (Even When They’re Right)

Many patients try to appeal on their own — and still lose — because they:

• Reuse generic appeal letters

• Focus on fairness instead of policy requirements

• Miss key arguments insurers expect to see

• Fail to challenge the denial the right way

• Don’t realize the appeal record can permanently close

Here’s the truth insurance companies don’t advertise:

If your appeal is denied and the record closes, you may never be allowed to fix missing arguments later.

That’s why choosing the correct appeal structure matters more than writing a long letter.

Choose the Right Appeal Letter Template for Your Denial

Below are the most common denial types and the exact appeal template designed for each one.

Each template is:

• Written by an insurance attorney

• Customizable for your situation

• Designed to challenge denials the way insurers actually review them

• Available for instant download ($29)

🩺 Denied as “Not Medically Necessary”?

Use the Medical Necessity Appeal Letter Template

This is one of the most common denial reasons.

Insurance companies often deny care by claiming it does not meet their internal medical necessity criteria — even when your doctor prescribed it.

This template helps you:

• Explain why the treatment is medically necessary for you

• Address insurer medical necessity guidelines

• Tie your medical records directly to coverage criteria

• Avoid vague or emotional arguments that get denied again

👉 [ Download the Medical Necessity Appeal Letter – $29 ]

🚑 Denied for Out-of-Network Care?

Use the Out-of-Network Appeal Letter Template

Out-of-network denials often involve large bills and limited patient choice.

Insurers frequently ignore:

• Emergency circumstances

• Lack of in-network providers

• Hospital-based providers you didn’t choose

This template helps you:

• Explain why in-network care was not reasonably available

• Address emergency and access exceptions

• Present a clear, factual record insurers must evaluate

👉 [ Download the Out-of-Network Appeal Letter – $29 ]

🕒 Denied Due to Prior Authorization?

Use the Prior Authorization Appeal Letter Template

Prior authorization denials are often paperwork-based, not medical.

Patients are frequently denied after receiving care their doctor ordered — because the insurer claims authorization was missing, delayed, or improperly processed.

This template helps you:

• Challenge whether prior authorization was actually required

• Address urgency and timing

• Explain reliance on provider instructions

• Prevent procedural denials from becoming permanent

👉 [ Download the Prior Authorization Appeal Letter – $29 ]

📄 Denied as “Not Covered” or Due to a Policy Exclusion?

Use the Policy Exclusion / Not Covered Appeal Letter Template

Policy exclusion denials often rely on broad or misleading interpretations of insurance contracts.

Insurers may ignore:

• Exceptions

• Definitions

• Cross-references that support coverage

This template helps you:

• Identify the exact policy language used to deny the claim

• Challenge the insurer’s interpretation

• Cite definitions, exceptions, and coverage provisions properly

👉 [ Download the Policy Exclusion Appeal Letter – $29 ]

🧬 Denied as “Experimental” or “Investigational”?

Use the Experimental Treatment Appeal Letter Template

“Experimental” does not automatically mean uncovered.

Insurers often deny newer drugs or therapies by relying on:

• Outdated criteria

• Broad policy definitions

• Internal guidelines that lag behind medical practice

This template helps you:

• Challenge whether the treatment actually meets the policy definition of “experimental”

• Present medical evidence and clinical support

• Address FDA approval, off-label use, and standard-of-care arguments

👉 [ Download the Experimental Treatment Appeal Letter – $29 ]

Why These Templates Work (When DIY Appeals Fail)

Insurance appeals are not creative writing.

They are:

• Technical

• Procedural

• Policy-driven

These templates were created by an insurance attorney with years of experience fighting insurance companies, and they are structured around how insurers actually evaluate appeals.

Each template:
✔ Uses the right arguments for the denial type
✔ Helps prevent appeal-record mistakes
✔ Saves hours of research and drafting
✔ Improves the chance of overturning the denial

How This Can Save You Thousands

Denied claims often involve bills of:

• $1,500

• $10,000

• $30,000 or more

Each template costs $29.

For many people, that’s the difference between:

• Accepting a denial, or

• Submitting a clear, properly structured appeal

$29 is small compared to the cost of giving up on a valid claim.

Not Sure Which Template You Need?

If you’re still figuring out the denial reason or want to understand the appeal process before filing, start with the FREE Health Insurance Appeal Guide.

It explains:

• How insurance appeals work

• Common mistakes that kill appeals

• How to read denial letters

• When external review may apply

📘 [ Download the FREE Health Insurance Appeal Guide ]

Insurance companies deny claims every day — and many denials are overturned only when appealed correctly.

The biggest mistake people make is using the wrong appeal strategy or giving up too soon.

This page exists so you don’t have to guess.

👉 Choose the appeal letter template that matches your denial and take action today.