Health Insurance Claim Denial & Coverage Dispute Letters
Navigate ERISA appeals, fight medical necessity denials, and demand coverage you're entitled to
How to Decode Your Explanation of Benefits (EOB) and Denial Letter
Health insurance denials are frustratingly common, affecting everything from routine procedures to life-saving treatments. The first step to fighting back is understanding what your insurer is actually saying.
Common Denial Reasons
Denial Category
What Insurer Claims
What It Usually Means
Medical Necessity
"Not medically necessary"
Insurer's reviewer (often not your specialist) disagrees with your doctor about whether treatment is needed
Experimental / Investigational
"Treatment is experimental or investigational"
Insurer claims treatment lacks sufficient evidence, even if FDA-approved or widely used
Out-of-Network
"Provider is out-of-network; reduced benefit"
You saw a non-contracted provider, triggering higher cost-sharing or denial (but exceptions exist)
Prior Authorization
"Prior authorization required but not obtained"
Insurer required advance approval; claim denied even if treatment was appropriate
Pre-Existing Condition
"Related to pre-existing condition"
Rare under ACA for most plans, but still possible for grandfathered or short-term plans
Coding / Billing Error
"Procedure code doesn't match diagnosis"
Often a technical issue; provider may need to resubmit with correct codes
Reading Your EOB
Your Explanation of Benefits (EOB) is not a bill—it's a statement showing how the insurer processed your claim. Key sections:
Service Date: When the care was provided
Provider: Who rendered the care
Billed Amount: What the provider charged
Allowed Amount: What the insurer considers reasonable (often less than billed)
Plan Paid: What the insurer actually paid
Your Responsibility: Your share (copay, coinsurance, deductible)
Reason Code: Why the claim was denied or adjusted (critical for appeals)
Tip: Look up the reason code in your plan's denial code guide (usually in your member portal or by calling customer service). Generic codes like "not medically necessary" require a detailed written explanation—demand it if you don't have one.
What You're Entitled to in a Denial Letter
Under federal law (ERISA § 503 for employer plans, ACA rules for others), your insurer must provide:
Specific reason for denial: Not just a code, but a clear explanation of why coverage was denied
Reference to plan provisions: The specific policy language or criteria used
Description of additional information needed: If applicable, what you can submit to appeal
Appeal rights and deadlines: How to challenge the denial and when you must act
Right to request claim file: You can demand copies of all documents the insurer relied on
Red Flag: If your denial letter is vague, lacks specific reasons, or doesn't explain your appeal rights, the insurer may have violated procedural requirements. This can strengthen your case and, in ERISA plans, may entitle you to a "de novo" (fresh) review in court.
ERISA vs Non-ERISA: Which Rules Apply to Your Plan?
Whether your health plan is governed by ERISA (the Employee Retirement Income Security Act) or state insurance law dramatically affects your rights and remedies. Here's how to tell the difference and what it means for your appeal.
Is Your Plan ERISA or Non-ERISA?
Plan Type
ERISA?
Key Characteristics
Employer-Sponsored Group Health (most common)
YES
Your employer offers the plan as a benefit; covers employees and dependents. Governed by federal ERISA law.
Self-Funded Employer Plan
YES
Employer pays claims directly (insurer just administers); common in large companies. Fully ERISA, no state insurance law applies.
Individual / Marketplace Plan (ACA Exchange)
NO
You bought coverage yourself via HealthCare.gov or state exchange. Governed by ACA and state insurance law.
Government Plans (Medicare, Medicaid, VA, Tricare)
NO
Federal or state government programs with their own appeal rules.
Church Plans
MAYBE
Some church-sponsored plans opt out of ERISA; check your plan documents.
How to Check: Look at your plan documents. ERISA plans must provide a Summary Plan Description (SPD) that includes a statement of ERISA rights. If your employer gave you the coverage, it's almost certainly ERISA. If you bought it yourself, it's not.
YES—must complete internal appeals before suing (with limited exceptions)
YES for ACA plans—internal + external review required in most cases
Remedies in Court
LIMITED—usually only benefits owed + attorney's fees. No punitive damages, pain/suffering, or bad faith damages.
BROADER—can include bad faith damages, emotional distress, punitive damages (under state law)
Where You Sue
Federal court only
State or federal court
Jury Trial?
NO—judge decides
YES—if suing under state law
Discovery
Limited; often just claim file review
Full discovery available
ERISA "Full and Fair Review" Requirements
If your plan is ERISA-governed, the insurer must provide a "full and fair review" of your appeal. This means:
You get to see adverse evidence: Any medical opinions, reports, or guidelines the insurer relied on must be shared with you before the appeal decision
Independent reviewer: The person reviewing your appeal cannot be the same person who made the initial denial, or their subordinate
No deference to initial decision: The appeal is supposed to be a fresh review
Timely decision: 30 days for pre-service (prior auth), 60 days for post-service claims, 72 hours for urgent care
Reason for denial: If appeal is denied, you must receive a clear explanation with specific references to plan terms
Procedural Violations = Stronger Case: If your ERISA plan violated these procedural requirements (e.g., didn't share adverse medical opinions, missed deadlines, used the same reviewer), courts may apply "de novo" review instead of deferring to the plan's decision. This dramatically improves your odds in litigation.
ACA Plans: Internal and External Review
For non-ERISA plans subject to the Affordable Care Act (most individual and small group plans), you have:
Internal appeal: At least one level of appeal within the insurance company
External review: If internal appeal is denied, you can request an independent external review by a third-party organization (IRO). The IRO's decision is binding on the insurer.
High success rate: External reviews overturn insurer denials approximately 40% of the time, especially for medical necessity disputes
External Review Is Powerful: Don't skip external review if your plan offers it. It's usually free, doesn't require an attorney, and is often faster than litigation. Many medical necessity denials are overturned at this stage.
Internal Appeals: Deadlines, Levels, and What You Must Include
Appealing a health insurance denial is a structured process with strict deadlines. Here's how to navigate it effectively.
Appeal Timeline Flowchart
Claim Denied
↓
Internal Appeal Level 1 (File within 180 days)
↓
Decision within 30-60 days (urgent: 72 hours)
↓
If Denied: Internal Appeal Level 2 (if required by plan)
↓
External Review (within 4 months of final internal denial)
↓
IRO Decision (binding on insurer) OR Litigation
Key Deadlines
Action
ERISA Plans
ACA Plans
File internal appeal
180 days from denial
180 days from denial
Insurer decision (post-service)
60 days
30 days (up to 60 with extension)
Insurer decision (pre-service / prior auth)
30 days
30 days
Urgent / expedited appeal decision
72 hours
72 hours
File external review
N/A (ERISA plans usually don't have external review)
4 months from final internal denial
Don't Miss Deadlines: Missing the 180-day deadline to file your internal appeal can permanently forfeit your right to challenge the denial. Mark your calendar immediately upon receiving a denial.
What to Include in Your Appeal Letter
A strong appeal is detailed, evidence-based, and tailored to the specific reason for denial. Include:
Your identifying information: Name, member ID, claim number, policy number
Statement that you are appealing: Clearly state "I am appealing the denial of [procedure/service] dated [date]"
Why the denial is wrong: Address the specific reason(s) cited by the insurer
Medical evidence: Letter from treating physician, peer-reviewed studies, clinical guidelines, FDA approvals, test results
Policy language: Quote the specific provisions that support coverage
Request for documents: Ask for the complete claim file, including any medical opinions or guidelines the insurer relied on
Request for oral presentation: Some plans allow you to present your case by phone or in person
Evidence Strategy by Denial Type
Denial Type
Key Evidence to Submit
Medical Necessity
Treating physician letter explaining why treatment is necessary; peer-reviewed studies; clinical practice guidelines (e.g., NCCN for oncology); notes from prior unsuccessful treatments
Experimental / Investigational
FDA approval status; compendia listings (e.g., NCCN, Micromedex, Drugdex); clinical trial phase; peer-reviewed articles; expert opinion; policy definition of "experimental"
Out-of-Network
Emergency care documentation; proof no in-network provider available; inaccurate provider directory evidence; balance billing protections (No Surprises Act); continuity of care rights
Prior Authorization
Proof authorization was submitted or wasn't required; emergency circumstances; plan failure to notify of requirement; retroactive authorization request
External Review and Regulator Complaints
After exhausting internal appeals, you can:
File for external review (ACA plans): Free, independent review by a medical expert. Decision is binding on the insurer. Success rate ~40%.
File a complaint with your state insurance department: Even if it doesn't overturn the denial, it creates a regulatory record and may prompt insurer action.
Contact the Department of Labor (ERISA plans): File a complaint if the plan violated procedural requirements (e.g., missed deadlines, didn't provide full and fair review).
Simultaneous Tracks: You can file a state insurance complaint AND pursue external review at the same time. They serve different purposes and don't interfere with each other.
Sample Health Insurance Appeal & Demand Letters
Sample 1: ERISA Internal Appeal – Medical Necessity Denial
[Your Name]
[Your Address]
[City, State ZIP]
[Phone]
[Email]
[Member ID: XXXXXXX]
[Date]
[Insurance Company Name]
Appeals Department
[Address]
[City, State ZIP]
RE: Internal Appeal – Denial of MRI Lumbar Spine
Claim Number: [CLAIM#]
Policy/Group Number: [POLICY#]
Patient: [Your Name]
Date of Service: [DATE]
Provider: [Provider Name]
Dear Appeals Coordinator:
I am appealing your denial dated [DENIAL DATE] of my claim for an MRI of the lumbar spine performed on [DATE]. Your denial states the procedure was "not medically necessary," a conclusion that directly contradicts my treating physician's judgment and clinical evidence.
PROCEDURAL REQUESTS
Pursuant to ERISA § 503 and 29 C.F.R. § 2560.503-1, I request:
1. A full and fair review of this claim
2. Copies of all documents, records, and medical opinions the plan relied upon in denying this claim, including:
- Any internal medical review notes
- Clinical guidelines or criteria applied
- Any independent medical examination reports
3. The opportunity for an oral presentation if this appeal is denied
4. The identity and qualifications of any medical professional who reviewed this claim
FACTS AND MEDICAL NECESSITY
On [DATE], I presented to my physician, Dr. [Name], with severe lower back pain radiating down my left leg, accompanied by numbness and tingling. I have been experiencing these symptoms for [TIMEFRAME], and conservative treatment including physical therapy, NSAIDs, and rest has failed to provide relief.
Dr. [Name] ordered the lumbar MRI to evaluate for disc herniation, spinal stenosis, or other structural abnormalities causing nerve compression. The MRI is essential to rule out serious conditions requiring surgical intervention and to guide appropriate treatment.
WHY YOUR DENIAL IS WRONG
Your denial cites failure to meet "medical necessity criteria" but provides no specifics about what criteria were applied or why my case doesn't satisfy them. This violates your obligation to provide a clear explanation.
**Evidence of Medical Necessity:**
1. **Treating Physician Support (Exhibit A):** Dr. [Name]'s letter, attached, explains that the MRI is medically necessary to diagnose the cause of radicular symptoms and to determine appropriate treatment. Dr. [Name] is a board-certified [specialty] with [X] years of experience treating spinal conditions.
2. **Clinical Guidelines:** The American College of Radiology (ACR) Appropriateness Criteria recommend MRI for patients with low back pain and radiculopathy lasting more than 6 weeks despite conservative treatment. I meet these criteria.
3. **Failed Conservative Treatment:** I completed 8 weeks of physical therapy (records attached as Exhibit B) with no improvement. I have tried multiple medications (prescription records, Exhibit C). Per standard of care, imaging is warranted when conservative measures fail.
4. **Red Flag Symptoms:** Progressive neurological symptoms (numbness, tingling) warrant urgent imaging to rule out cauda equina syndrome or other surgical emergencies.
Your plan's medical reviewer—who has never examined me—cannot reasonably substitute their judgment for that of my treating specialist who has evaluated me in person and reviewed my complete medical history.
POLICY LANGUAGE SUPPORTS COVERAGE
The plan's Summary Plan Description states that "medically necessary" services are covered. The SPD defines medically necessary as services that are "appropriate and consistent with the diagnosis and that could not have been omitted without adversely affecting the member's condition or the quality of medical care rendered."
The MRI unquestionably meets this standard. It is the appropriate diagnostic tool for suspected nerve compression, and omitting it would adversely affect my care by preventing accurate diagnosis and treatment planning.
REQUEST FOR IMMEDIATE APPROVAL
I request that you immediately approve this claim and reimburse the medical provider $[AMOUNT] for the MRI performed on [DATE]. The MRI has already been completed because my physician deemed it urgent given my worsening neurological symptoms. Delayed diagnosis poses significant risk of permanent nerve damage.
If you do not approve this appeal within the required 60-day timeframe, I will pursue all available remedies, including filing a complaint with the U.S. Department of Labor and pursuing litigation under ERISA § 502(a).
Please send your written decision and all supporting documents to the address above. You may also reach me at [PHONE] or [EMAIL].
Sincerely,
[Your Signature]
[Your Printed Name]
Enclosures:
Exhibit A: Physician Letter of Medical Necessity
Exhibit B: Physical Therapy Records
Exhibit C: Prescription Records
Exhibit D: ACR Appropriateness Criteria (excerpts)
[Your Name]
[Your Address]
[City, State ZIP]
[Phone]
[Email]
[Policy #: XXXXXXX]
[Date]
[State Insurance Department / IRO Name]
External Review Program
[Address]
RE: Request for External Review – Experimental Treatment Denial
Insurance Company: [INSURER NAME]
Policy Number: [POLICY#]
Internal Appeal Denial Date: [DATE]
Patient: [Your Name]
Diagnosis: [CONDITION, e.g., Stage IV Non-Small Cell Lung Cancer]
Denied Treatment: [DRUG/PROCEDURE NAME]
Dear External Review Coordinator:
I request an independent external review of [Insurance Company]'s denial of coverage for [Treatment/Drug Name], which my oncologist prescribed to treat my [Condition]. The insurer has denied this treatment as "experimental and investigational," a conclusion that is factually and medically incorrect.
BACKGROUND
I was diagnosed with [Condition] on [DATE]. After failing first-line treatment with [Prior Treatment], my oncologist, Dr. [Name] at [Institution], recommended [Denied Treatment] based on:
1. FDA approval for my specific indication ([DATE] approval)
2. Inclusion in NCCN Clinical Practice Guidelines as a Category 1 (preferred) treatment option
3. Peer-reviewed evidence demonstrating efficacy and safety
4. My specific tumor markers / genetic profile indicating likely response
The insurer denied coverage on [INITIAL DENIAL DATE], and I appealed internally on [APPEAL DATE]. My internal appeal was denied on [FINAL DENIAL DATE], exhausting internal remedies.
WHY THE DENIAL IS WRONG
**1. FDA Approval:** [Drug] received FDA approval on [DATE] for treatment of [specific indication]. The FDA approval was based on clinical trials demonstrating [results, e.g., improved overall survival, progression-free survival]. This is not "experimental"—it is an FDA-approved, evidence-based treatment.
**2. NCCN Guidelines:** The National Comprehensive Cancer Network includes [Drug] in its guidelines for [Condition] as a Category 1 recommendation, meaning there is high-level evidence and uniform consensus that it is appropriate. (NCCN Guidelines excerpt attached as Exhibit A.)
**3. Compendia Listing:** Under 45 C.F.R. § 147.136, plans must base medical necessity determinations on objective criteria. [Drug] is listed in recognized compendia including:
- NCCN Drugs & Biologics Compendium
- Micromedex
- AHFS Drug Information
The insurer's policy states it covers treatments listed in these compendia, yet it denied my claim in direct contradiction of its own policy language.
**4. Treating Oncologist Support:** Dr. [Name], a board-certified medical oncologist specializing in [cancer type] with [X] years of experience, has submitted a detailed letter (Exhibit B) explaining why this treatment is medically necessary and represents the standard of care for my condition.
**5. Peer-Reviewed Evidence:** I am submitting three peer-reviewed articles from major medical journals (Exhibit C) demonstrating the efficacy of [Drug] for [Condition]. This is not "experimental"—it is evidence-based medicine.
The insurer's medical reviewer applied outdated or incorrect criteria, likely relying on a generic denial template rather than reviewing the specific evidence of FDA approval and guideline inclusion.
IRREPARABLE HARM
My cancer is progressing. Every day without effective treatment increases the risk of metastasis, organ failure, and death. The insurer's delay in approving this life-saving treatment is not just a bureaucratic inconvenience—it is placing my life in jeopardy.
I have been forced to delay starting this treatment due to cost (out-of-pocket would be $[AMOUNT]/month, which I cannot afford). The delay has caused significant emotional distress, anxiety, and worsening of my condition.
REQUEST
I respectfully request that the Independent Review Organization:
1. Overturn the insurer's denial
2. Order immediate coverage of [Drug] for the duration of my treatment
3. Order the insurer to reimburse any costs I have incurred due to the delay
I authorize the IRO to request and review my complete medical records from [Provider/Institution]. Please contact my oncologist, Dr. [Name], at [Phone] with any questions.
Thank you for your prompt attention to this urgent matter.
Sincerely,
[Your Signature]
[Your Printed Name]
Enclosures:
Exhibit A: NCCN Guidelines (relevant pages)
Exhibit B: Oncologist Letter of Medical Necessity
Exhibit C: Peer-Reviewed Journal Articles (3)
Exhibit D: FDA Approval Letter/Label
Exhibit E: Insurance Policy Language re: Experimental Treatment
Sample 3: Out-of-Network Appeal – No Surprises Act / Emergency Care
[Your Name]
[Your Address]
[City, State ZIP]
[Phone]
[Email]
[Member ID: XXXXXXX]
[Date]
[Insurance Company Name]
Appeals Department
[Address]
RE: Appeal of Out-of-Network Denial – Emergency Services
Claim Number: [CLAIM#]
Policy Number: [POLICY#]
Date of Service: [DATE]
Provider: [Hospital/Provider Name]
Amount in Dispute: $[AMOUNT]
Dear Appeals Coordinator:
I am appealing your denial dated [DATE] of my claim for emergency room services provided on [DATE] at [Hospital Name]. You denied the claim as "out-of-network with reduced benefits," leaving me with a balance of $[AMOUNT]. This denial violates federal law and your policy's emergency care provisions.
FACTS
On [DATE], I experienced [symptoms: severe chest pain, difficulty breathing, etc.] and reasonably believed I was having a medical emergency. I called 911, and paramedics transported me to the nearest emergency room, [Hospital Name].
I did not choose this hospital—it was an emergency, and I went where the ambulance took me. I later learned that [Hospital Name] is out-of-network under my plan, but at the time, I was focused on getting urgent medical care, as any reasonable person would be.
I was diagnosed with [condition] and received [treatment]. I was discharged [same day / after X days].
APPLICABLE LAW: NO SURPRISES ACT
The No Surprises Act (effective January 1, 2022) prohibits balance billing for emergency services at out-of-network facilities. Under 45 C.F.R. § 149.110, plans must:
1. Cover emergency services without requiring prior authorization
2. Cover emergency services without regard to whether the provider is in-network
3. Apply in-network cost-sharing (copay/deductible) even if the facility is out-of-network
4. Not impose higher cost-sharing for out-of-network emergency care
Your denial violates these requirements by applying a reduced out-of-network benefit and leaving me with a balance. Federal law requires you to treat this claim as if [Hospital Name] were in-network.
POLICY LANGUAGE
Your plan's Summary of Benefits states: "Emergency services are covered at in-network cost-sharing levels regardless of whether the provider is in or out of network."
Your denial contradicts your own policy language.
EVIDENCE OF EMERGENCY
The medical records (attached as Exhibit A) document that I presented with symptoms that a prudent layperson would reasonably believe constituted an emergency requiring immediate care. Under the "prudent layperson standard," the determination is based on symptoms, not the final diagnosis.
The Emergency Medical Treatment and Labor Act (EMTALA) required [Hospital Name] to provide stabilizing treatment. I had no choice in where to receive care.
DEMAND
I demand that you:
1. Reprocess this claim applying in-network cost-sharing
2. Pay [Hospital Name] the full in-network allowed amount
3. Reduce my patient responsibility to the in-network copay of $[AMOUNT]
4. Refund any excess payments I have made
Under the No Surprises Act, I cannot be balance-billed by the provider for the difference. The provider must accept the plan's payment as payment in full (subject to my in-network cost-sharing). Your failure to pay the claim correctly leaves the provider unable to collect and leaves me with improper bills.
If you do not correct this claim within 30 days, I will file a complaint with the U.S. Department of Labor and the [State] Department of Insurance, and I will pursue all available legal remedies.
Please contact me at [Phone] or [Email] with your corrected claim determination.
Sincerely,
[Your Signature]
[Your Printed Name]
Enclosures:
Exhibit A: Emergency Room Records
Exhibit B: Ambulance Report
Exhibit C: Plan Summary of Benefits (emergency services section)
Special Issues: Behavioral Health, Experimental Treatments, Surprise Billing
Behavioral Health Parity
Federal law (Mental Health Parity and Addiction Equity Act) requires health plans to cover mental health and substance use disorder treatment on par with medical/surgical benefits. Common violations:
Higher cost-sharing: Charging higher copays/deductibles for mental health than for other care
Stricter prior authorization: Requiring pre-approval for MH/SUD treatment but not for comparable medical treatment
More restrictive visit limits: Capping therapy sessions but not physical therapy sessions
If You Suspect Parity Violations: Request the plan's comparative analysis showing that MH/SUD treatment limits are no more restrictive than limits on medical/surgical care. Plans are required to provide this upon request. File complaints with DOL and state regulators.
Surprise Billing Protections
The No Surprises Act (effective January 2022) protects patients from surprise medical bills in these situations:
Scenario
Protection
Emergency services at out-of-network facility
You pay only in-network cost-sharing; no balance billing allowed
Out-of-network provider at in-network facility (e.g., anesthesiologist, pathologist)
You pay only in-network cost-sharing unless you give advance written consent
Air ambulance (out-of-network)
You pay only in-network cost-sharing; no balance billing
If you receive a surprise bill, you can initiate a federal independent dispute resolution (IDR) process to resolve the payment dispute between the provider and insurer—at no cost to you.
Experimental Treatment: Challenging the Label
Insurers often label cutting-edge treatments "experimental" to deny coverage, even when there's substantial evidence of efficacy. Strategies to challenge:
FDA approval: If the drug/device is FDA-approved for your indication, it is NOT experimental by definition
Off-label use with compendia support: Many cancer drugs are used off-label but are listed in NCCN or other recognized compendia—plans must cover these
Clinical trial phase: Phase III or later trials generally indicate a treatment is beyond "experimental" stage
Treating physician expertise: Oncologists, rare disease specialists, and other experts can provide powerful evidence that a treatment is standard of care in their field
Lack of alternatives: If all standard treatments have failed, denying access to a promising new treatment may be unreasonable, especially in life-threatening conditions
Beware of Generic Denials: Many "experimental" denials are issued using boilerplate language without individualized review. Demand the specific evidence the insurer relied upon. If they cannot produce a detailed, case-specific analysis, the denial may be arbitrary.
Attorney Services for Health Insurance Disputes
Navigating health insurance denials can be overwhelming, especially when you're also dealing with illness or injury. An experienced health insurance attorney can significantly improve your chances of success.
When to Hire an Attorney
High-value claims: If the treatment costs $50,000+, the stakes justify legal help
Life-threatening conditions: When delay in treatment poses serious health risks, attorneys can seek emergency relief
ERISA litigation: ERISA cases are procedurally complex; specialized attorneys know how to build a strong record
Procedural violations: If the plan violated appeal deadlines, didn't provide full and fair review, or failed to disclose adverse evidence
Bad faith (non-ERISA plans): If you have an individual plan and the insurer's conduct was egregious, you may recover extra-contractual damages
What an Attorney Can Do
Strengthen your appeal: Draft detailed legal and medical arguments, work with medical experts, cite case law
Obtain claim file: Use legal tools to get the insurer's complete claim file, including internal communications that may show bias or bad faith
Litigate in federal court: File ERISA lawsuit with proper record development and expert testimony
Negotiate settlements: Insurers often settle once a skilled attorney is involved, knowing that litigation is expensive for them too
Seek emergency relief: File for preliminary injunction requiring the insurer to cover treatment immediately while the case proceeds
Attorney Fees in ERISA Cases: If you win an ERISA lawsuit, the court has discretion to award attorney's fees. Many ERISA attorneys work on contingency or reduced hourly rates, making representation affordable even for individuals.
Questions to Ask a Prospective Attorney
How many health insurance denial cases have you handled?
Do you have experience with ERISA litigation specifically?
Have you handled cases involving my type of treatment or condition?
What is your fee structure? (Hourly, contingency, hybrid?)
Do you work with medical experts? How do you find them?
What are the realistic timelines and potential outcomes for my case?
Submit Your Case for Review
If your health insurance claim has been denied, don't give up. I have successfully recovered coverage for clients facing medical necessity denials, experimental treatment denials, and bad faith claim handling.
Send me your denial letter, EOB, medical records, and policy documents for a case review. I'll assess your appeal options and discuss representation.
I handle ERISA and non-ERISA plans. Contingency fees available for qualifying cases.
Additional Resources
Patient Advocate Foundation: Free case management for insurance denials – www.patientadvocate.org