A professionally crafted appeal letter citing ACA regulations and denial-specific legal grounds.
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Your insurer claims the treatment is not medically necessary.
Denied coverage for an out-of-network provider or emergency.
Claim denied because prior authorization was not obtained.
Incorrect billing codes led to a wrongful denial.
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Dear Anthem Blue Cross Appeals Department,
I am writing to formally appeal the denial of Claim #HC-2026-44821, dated January 28, 2026, for an MRI of the lumbar spine. The denial cites “not medically necessary” as the reason for non-coverage.
Under the Affordable Care Act (42 U.S.C. § 300gg-19), I have the right to appeal any adverse coverage determination. My treating physician, Dr. Robert Chen, has determined this procedure is medically necessary to diagnose the source of chronic radiculopathy that has not responded to conservative treatment over the past 12 weeks.
I request a full and fair review of this denial in accordance with federal and state regulations.
Sincerely,
Rachel M. Torres
Provide your insurance denial details and we’ll draft a professional appeal letter customized to your situation.
After payment, check your email in 5-10 minutes. For support, contact hello@denialfighter.com or (646) 397-6421.
An appeal is a formal request to your insurance company to reconsider a denied claim. Under the ACA, you have the right to appeal any denial, and insurers must review appeals by a different person than the one who made the original decision.
Most insurers allow 180 days (6 months) from the date of denial to file an internal appeal. Check your denial letter for specific deadlines, as some plans have shorter windows.
Studies show that approximately 40-60% of internal appeals result in the denial being overturned. Having a well-written, documented appeal significantly increases your chances.
No. You have the right to file an appeal yourself. DenialFighter creates a professional appeal letter citing relevant regulations and medical justifications appropriate for your denial type.
Contact hello@denialfighter.com within 24 hours for revisions or a full refund.
This appeal letter is a template generated by DenialFighter, a service of Immutable Software LLC. It is not sent by an attorney, and does not constitute legal or medical advice. This letter states facts as provided by the user and references generally applicable insurance regulations. For legal advice specific to your situation, consult a licensed attorney or patient advocate.