Guidance for health insurance claim denials
If your insurance claim is denied, build a communication playbook, schedule follow-ups, and escalate at the right time.
guidemyclaim.com is not a law firm and does not provide legal advice.
Roughly 40–80% of appealed health claim denials get overturned—yet under 1% of denials are appealed.
Share the type of care, what you’ve been told so far, and the closest match to their reason—like out-of-network or missing pre-auth. We don’t judge your case or read your policy for you; we provide you with a clear and actionable path to case resolution.
Different scenarios require different asks: clarifying a bill code, requesting missing documents, or asking the plan to explain a decision in writing. We help remove the guesswork and provide you with a clear path forward.
Claims often stall because communication drops off. We help you keep the process moving with timely follow-ups and escalation prompts.
See how your playbook stays actionable from the first message through follow-up.
Denial received, reason unclear
Ask insurer to clarify denial basis
Draft message
Hello, I received a denial notice for this claim and need clarification. Please explain why it was denied, which policy rule applies, and exactly what I should provide to move this forward.
wait 5 days
notify me on receipt of new communication
Build your playbook, draft messages, and stay on top of follow-ups.
A few questions about your care, what the plan has said, and any paperwork you already have—optional uploads stay yours.
Suggestions that match your situation: how to ask for a review, clarify coding, supply documents, or request a clear written explanation.
Simple pacing so a slow reply doesn’t turn into forgetting. You copy, send, and keep a record of what you tried in your playbook.
One payment per medical claim — no subscription.
$29 per claim, one-time
Charged after you provide your case details and before unlocking your playbook.