Insurer denied, delayed, or underpaid your claim? Draft the appeal that fights back.
A properly cited appeal built from your plan or policy terms and the rules that bind your insurer. Preview it free.
53%1 of the denials consumers appealed were overturned. The denial counts on you not filing one.
- I write to formally appeal the denial dated April 2, 2026 of
- coverage for laparoscopic cholecystectomy (CPT 47562). The
- denial states the service was "not medically necessary." I
- respectfully disagree.
- Under 29 CFR § 2560.503-1 (ERISA), you are required to provide
- a full and fair review. Per 45 CFR § 147.136,
- non-grandfathered plans must cover services determined
- medically necessary by a treating physician. My treating
- physician Dr. Rafael Ortega documented acute cholecystitis
- confirmed by ultrasound on February 27, 2026...
Health-plan excerpt. The full letter adds the denial reference, an argument built on your physician's documentation, the review rules the plan is bound by, a specific request (reversal, peer-to-peer review, or external review), and a signature block. An auto appeal is a different letter built from your policy.
What's actually happening.
Your insurance just denied a claim: a medication, a procedure, a surgery, a service. The denial letter is intentionally confusing and the appeal process is intentionally exhausting. Most people give up. The system works as designed: deny first, approve on appeal when challenged. You just need to file.
The same form handles the other kind of insurance fight: an auto carrier that denied the claim on an exclusion, totalled your car at a number no comparable vehicle sells for, cut the body shop's estimate, or decided the accident was your fault.
You tell us which kind of insurance this is on the first question, and that answer picks the framework. A health-plan appeal argues the plan's own terms and the federal review rules that bind it. An auto appeal argues your policy contract, the valuation or estimate itself, and the claim-handling standards your state's regulator expects. Only one of those goes into your letter.
How it works.
Upload the notice, answer a few questions
A photo, a PDF, or the pasted text of what they sent you. Then the minimum we need: your name, what happened, any context.
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Laws we cite.
Every letter is grounded in real statutes and regulations. These are the ones that apply here.
29 CFR § 2560.503-1 Employee Retirement Income Security Act (ERISA). Requires full and fair review of adverse benefit determinations for employer-sponsored plans.
45 CFR § 147.136 ACA internal appeal rights for non-grandfathered individual and group health plans.
ERISA § 503 Federal appeal rights for employer-sponsored benefit plans, including timelines and documentation requirements.
45 CFR § 147.136(d) ACA external review. Where an internal appeal on a non-grandfathered plan is denied, the letter can note the right to escalate to independent external review and the four-month window for requesting it.
MHPAEA (29 USC § 1185a) Mental health parity. Mental health and substance use benefits cannot be treated more restrictively than medical or surgical ones. Invoked where the denial is for that kind of care.
Your auto policy On an auto claim the policy is the primary ground: its coverage grants, exclusions, conditions, and duties are what the appeal argues from. Federal health-plan rules have no application to it and never appear in that letter.
Appraisal clause Most, though not all, auto policies contain an appraisal provision for a disagreement over the amount of a loss: each side appoints an appraiser and the two pick an umpire. The letter references it as something your policy may contain, not as an established right, unless you supply the clause.
NAIC Model Act #900 The Unfair Claims Settlement Practices Act most states model their insurance code on: prompt acknowledgement, reasonable investigation, good-faith settlement. Referenced descriptively on an auto appeal, alongside your state Department of Insurance as the escalation path. The letter never alleges bad faith as a legal conclusion.
Deadlines.
Most health plans give you 60 to 180 days from the denial date to file an internal appeal, and the denial letter must state your exact deadline. Auto claims run on your policy and your state. 29 CFR § 2560.503-1
Who this isn't for.
We are honest about our limits. FightThis may not be right if:
- Your denial involves Medicare or Medicaid. Those have separate federal appeal paths.
- The disputed amount is over $100,000. You should have an attorney involved.
- You are in active litigation with your insurer, or already in arbitration or appraisal with an auto carrier.
- You want us to arrange the peer-to-peer review itself. The letter can request one between your physician and the insurer's reviewer, but scheduling and conducting it is between them and your doctor's office. FightThis drafts the request, not the review.
- Your auto claim is against another driver's insurer rather than your own carrier under your own policy. A third-party liability claim has no contract behind it and is not what this letter argues.
- Anyone was injured in the accident. An injury claim needs a personal-injury attorney, not a letter.
If your situation is high-stakes, please find a local attorney. Many state bars have free or low-cost referral services.
Common questions.
How long do I have to appeal?
On a health plan, most give you 60 to 180 days from the denial date for an internal appeal, and your denial letter is legally required to state the exact deadline. On an auto claim it depends on your policy and your state: some policies set an internal deadline, and states set an outer limit on when suit can be brought on the contract. Either way, check the letter and the policy, and don't sit on it.
What if I already tried to appeal and they denied it again?
On a non-grandfathered health plan, exhausting internal appeals generally opens the right to independent external review, and the request has to be made within four months of the final internal denial. The letter can ask for that escalation directly. On an auto claim the next steps are different: a complaint to your state Department of Insurance, or invoking the appraisal clause where the disagreement is over the amount of the loss.
Does this work for Medicare?
Medicare has its own separate appeal process, which this does not cover. FightThis handles commercial health insurance (employer plans and ACA marketplace plans) and first-party auto claims under your own policy. For Medicare, visit medicare.gov/appeals.
Does this cover auto insurance too?
Yes. Pick "auto / vehicle insurance" on the first question and the form asks for claim and policy details instead of member ID and CPT codes, and the letter is drafted to your carrier's claims department. It covers a claim denied outright, a total-loss valuation you think is too low, an underpaid repair estimate, a disputed fault determination, and unreasonable delay. There is a dedicated page for it at /vehicle-insurance-appeals: same form, same price.
What if the denial was for a mental health or substance use service?
Mental health parity rules (MHPAEA) give you additional protections. Our letter will specifically invoke these where applicable.
Will I need my doctor to write anything?
On a health-plan appeal, a supporting letter from your treating physician helps significantly, and the treating physician's documentation is what the argument leans on. The letter can request a peer-to-peer review between your doctor and the plan's reviewer as part of the appeal. On an auto appeal the equivalent is documentary: independent estimates, comparable-vehicle listings, photos, and receipts.
What if my employer is self-insured?
Self-insured plans are governed by ERISA and are exempt from state insurance laws. Our letter handles this. We identify the right framework based on your plan type.
We mail it for you
Appeal windows are set by your plan document or your policy, and they are shorter than people expect. Mail it certified with tracking through FightThis: dated proof that the insurer received it, and when.
Recommended: Certified Mail, $19.99. See all mailing options.
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