Denied Care? How to Handle a Health Insurance Denial

Traci Arieli
6 days ago
4 min read

You open the letter, read the words, and your heart sinks: your claim has been denied. Whether it’s a procedure you expected to be covered or a medication you’ve relied on, you’re left wondering what to do next.

As an end-of-life doula, I support clients through this stress. Advocacy is a part of my work, and helping with insurance denials is a part of that. I’ve seen how confusing, exhausting, and even scary this process can be, especially when someone is already managing a serious health condition.

But here’s the good news: a denial isn’t always the end of the road. You have the right to fight back, and there are tools and strategies to help you do it.

Why Claims Get Denied

Health insurance denials can happen for many reasons, and not all make sense. Sometimes, it’s a technicality, like the wrong billing code or a missed deadline. Other times, the insurance company may question whether a procedure is “medically necessary,” even when your doctor recommends it.

There are two common types of denials:

Pre-service denials happen before you receive care, often due to a lack of prior authorization.
Post-service denials show up after the care has been provided, leaving you with a surprising and often overwhelming bill.

Both are stressful. And both can be appealed.

It’s important to remember that denial doesn’t mean you did anything wrong. The system is complicated by design, and even people who follow every step carefully still find themselves denied.

How to Respond to a Health Insurance Denial: First Steps

When you receive a denial letter, the first instinct might be to panic, but the best first move is to pause, breathe, and get organized. Here’s what to do:

Read the Denial Carefully. It will outline why the claim was denied and how long you have to appeal. Look for terms like “medical necessity,” “not covered,” or “out-of-network.”
Check the Deadline. Appeals are time-sensitive. You might have as little as 30–60 days to respond. Mark it on your calendar, and don’t wait.
Call Your Provider’s Office. Sometimes, the denial was also sent to them, and they may be able to handle the appeal on your behalf or at least help with supporting documentation.
Gather Documents. Pull together any relevant records, doctor’s notes, or test results that support why the care was necessary. These will strengthen your appeal.
Don’t Assume the First No Is Final. Many people give up here. Don’t. Insurance companies expect you won’t push back, so appealing matters.

Appeal with Confidence

Writing an appeal letter might sound overwhelming, but it doesn’t have to be. You don’t need legal jargon; you just need to be clear, concise, and persistent.

Here’s how to get started:

Stick to the Facts. State what was denied and why you believe it was medically necessary, and include any supporting documents. A short, well-organized letter is better than a long, emotional one.
Use Templates and Tools. You don’t have to start from scratch. Many organizations offer sample appeal letters, and there are tools that can generate one for you based on your specific denial. See https://fighthealthinsurance.com for more help.
Enlist Your Provider’s Help. Ask your doctor if they’re willing to write a letter of medical necessity. This can significantly strengthen your appeal.
Keep Copies of Everything. Save a copy of your appeal and proof that you submitted it (fax confirmation, certified mail receipt, etc.). You might need this if you have to escalate later.

Appealing is about standing up for the care you need. And you don’t have to do it alone.

Smart Tools to Help

Fighting a denial doesn’t mean you have to figure it out yourself. There are tools designed to guide you through the process, some free, some supported by nonprofits, and some powered by AI.

One standout tool is Fight Health Insurance (https://fighthealthinsurance.com), a free website that helps generate customized appeal letters based on your denial. You can upload your denial notice or type out a summary, and the system will walk you through a series of questions. It even helps identify what kind of documentation could strengthen your case. Once you’re done, it produces a ready-to-send letter you can mail, fax, or submit to your insurer.

Other support options include:

Hospital patient advocacy teams often know the appeal process inside and out.
Provider billing staff offices have specialists dedicated to handling insurance issues.
State health consumer hotlines offer free assistance navigating denials.

You’re not expected to be an expert. The key is finding the right support and using it.

Know Your Rights & Resources

If your initial appeal is denied, it’s not over. In many cases, you can escalate your appeal.

Here are a few key resources and rights to keep in mind:

Independent Medical Review Boards - If your plan allows, you can request an external review by a third-party medical expert. These reviewers are separate from your insurance company and may overturn their decision.
Employer-Provided Insurance? Talk to HR - If your insurance is through your employer, sometimes HR can advocate, especially if the denial affects your ability to work.
Patient Assistance Programs - Many hospitals and pharmaceutical companies offer help covering treatment costs, especially if you’ve been denied coverage.
Negotiating Medical Bills- Even if the denial sticks, remember: almost every medical bill is negotiable. Ask for itemized charges, request financial aid, or set up payment plans.
Nonprofits and Legal Aid - Some organizations specialize in healthcare advocacy and can help you navigate appeals or file complaints with your state’s insurance commissioner.

You have more options than it may feel like and more allies than you might expect.

A denial can feel overwhelming, but it’s not the end of the story. Many denials are reversed on appeal, especially when patients push back with facts, documentation, and support.

You don’t need to be an expert in insurance law. You just need to take it one step at a time, lean on the tools and people available to you, and remember this:

You are not alone.

Millions of people have faced denials, and many have successfully challenged them. Whether you’re advocating for yourself or a loved one, you can ask questions, demand fairness, and fight for the care you need.