Insurance Denied My Claim — What Do I Do?

Step 1: Read Your Denial Letter Today

Open your EOB or denial notice and find three things: the reason the claim was denied, the dollar amount you are being asked to pay, and the appeal deadline. The reason code — usually a two-digit CARC code — tells you why the payer rejected the claim. The deadline is typically 180 days from the denial date. Write both on your calendar immediately.

Step 2: Call Your Provider's Billing Office

Before filing your own appeal, call the doctor or hospital billing department. Ask whether they plan to appeal the denial on your behalf. Many provider offices handle appeals for claims they submitted. If they will appeal, confirm the timeline and ask for a reference number. If they will not appeal, you need to file a patient appeal yourself using the instructions on your denial letter.

Step 3: Gather Your Documents

• EOB or denial letter with reason codes
• Original itemized bill from your provider
• Medical records supporting the service if denied for medical necessity
• Prior authorization approval if the denial cites missing auth

Step 4: File Your Written Appeal Before the Deadline

Write a letter stating your name, member ID, claim number, and why you believe the denial is incorrect. Attach your supporting documents. Submit via the method listed on your denial notice — portal, fax, or mail. Keep a copy with proof of submission date. If your first appeal is denied, you typically have the right to a second-level appeal and external review.