Appeal a denied health insurance claim

AI matches the denial reason to plan language and medical-necessity criteria and drafts an appeal with your doctor's support.

Realistic savingsIllustrative: denied claims range from a few hundred dollars to tens of thousands; internal appeals and external review can overturn denials.

DifficultyMedium

Time2-5 h

Real-world reports

We haven't yet found a well-documented AI-specific case for this recipe; the savings range above is illustrative. Send us yours.

Tools

ChatGPT, Claude, Gemini or Grok (free tiers work; paid ~$20/mo helps with long files)
Denial letter, policy, doctor's letter

Steps

Request the claim file and the specific criteria used to deny.
Ask AI to map the denial reason to policy text and list evidence needed.
Get a letter of medical necessity from your doctor.
File the internal appeal before the deadline (often 180 days); request external review if denied.

Copy-paste prompt

Denial letter [PASTE]. Plan language [PASTE]. Draft an internal appeal: cite the plan sections, rebut the denial reason, list attached evidence, and request the external review process if upheld.

What to verify

Check deadlines on the letter; have your doctor's office review medical claims.

Legal & ethical notes

Never invent medical facts.

Official sources

HealthCare.gov appeals

Educational only; not legal, tax, medical or financial advice. Laws and prices change; check official sources.

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