How to appeal a health insurance denial

In our 2025 survey, 84% of LGBTQ+ adults said they had struggled with insurance. In the 2022 U.S. Transgender Survey, 26% of respondents had a problem with their insurer in the past year, like being denied coverage for gender-related care. A denial isn't always the final word. Under the Affordable Care Act, most plans have to give you two chances to change it.

Step 1: Read the denial letter

Your insurer has to tell you why it said no and how to appeal. Look for the reason (for example, "not medically necessary" or "not a covered benefit"), the deadline, and the forms you need.

Step 2: File an internal appeal

This asks your insurance company to take a full and fair second look. According to HealthCare.gov:

• You have 180 days from the denial notice to file.
• The insurer has 30 days to decide if you haven't had the service yet, and 60 days if you have.
• Urgent cases have to be decided faster.

Include your name, claim number, and insurance ID, plus anything that supports your case, like a letter from your provider explaining why you need the care.

Step 3: Ask for an external review

If the internal appeal fails, you can ask an independent reviewer outside the company to decide. You have 4 months after the final denial to ask. A standard review has to be decided within 45 days, and an urgent one within 72 hours. Your insurer is required by law to accept the reviewer's decision.

“Your insurer is required by law to accept the external reviewer's decision.”

Get help if you need it

Many states have a consumer assistance office that helps people with appeals for free. Your state insurance department can point you to it. If you think the denial was discrimination, our guide on what to do after a bad experience covers where to report it.

This article is general information, not legal advice. Plans through an employer that pays claims itself can follow slightly different rules.