Questions & answers · Health insurance
My health insurance denied my claim for an illness or injury. Why, and is that allowed?
Health insuranceDeniedChecked Nov 6, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: govinfo · 29 CFR 2590.715-2719 · § 2590.715-2719(b)(2)(ii)(E) View original ↗
In short
- A denial letter must say what was denied and give a code with its meaning.
- It must also tell you how to appeal.
- The letter is your starting point.
What this means
Under the federal rule for health plans, a denial notice has to identify your claim (date, provider, amount), give the denial code and what it means, and describe how to appeal and ask for outside review [1]. If the letter does not do these things, that is worth raising with the plan in writing.
The sources here do not say whether your particular denial was correct. Only your plan documents and the plan can answer that. You can ask the plan for the documents and records it relied on, free of charge [2]. HealthCare.gov says you must file an internal appeal within 180 days (6 months) of receiving notice that your claim was denied [3].
Your next step
Read the denial code and its meaning in your letter. Write down the date you got it. Ask the plan in writing for the documents it used. Appeal deadline: 180 days after you receive the notice.
Check it yourself
Compare your letter to the list above: claim date, provider, amount, denial code, appeal steps. Whether the denial itself was right is "Don't know yet" from these sources.
Where this comes from (3)
[1] govinfo · 29 CFR 2590.715-2719 · § 2590.715-2719(b)(2)(ii)(E) · checked 2026-11-06
includes information sufficient to identify the claim involved (including the date of service, the health care provider, the claim amount (if applicable) … includes the denial code and its corresponding meaning … a description of available internal appeals and external review processes, including information regarding how to initiate an appeal.
[2] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(h)(2)(iii)-(iv) · checked 2026-11-06
Provide that a claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant's claim for benefits.
[3] HealthCare.gov · Internal appeals · page text · checked 2026-11-06
You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied.
How we found this
We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.
What we don’t know yet
Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.
Every answer is checked against the official rule it quotes.
Information only — not legal advice. Your plan, insurer or agency decides.
This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.
Related answers
- Do I need prior authorization before going to the emergency room?
- Medicaid denied my claim saying I have other insurance, but I don't. What can I do?
- Medicare denied my "Welcome to Medicare" visit and I got a big bill. What can I do?
- My Medicaid application was denied. How long should a decision take, and how do I appeal?
Answer id CQ5002. Spotted an error? Tell us.