Appealing a Denied Claim

One in five in-network health insurance claims on the federal marketplace was denied in 2023, according to KFF analysis of transparency data. Fewer than one percent of those denials were appealed. Of the families who did appeal, 44% had the denial overturned. Those three numbers tell the story of insurance appeals in the United States: denials are common, appeals are rare, and appeals work far more often than most families expect. This guide covers the rights the Affordable Care Act guarantees, the sequence that moves a denied claim toward reconsideration, and the specific elements a strong appeal letter contains.