40 to 60% of insurance appeals are successful. Most people never try.
You had the surgery, the ER visit, the lab work. Now your insurer says they won't cover it. Federal law gives you the right to appeal. Upload your denial letter. We build your case, a specialist reviews it, and we send it to your insurer by fax and certified mail. You just sign.
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From denial letter to appeal sent, we handle the hard part.
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All you need is your denial letter or EOB. Snap a photo or upload a PDF.
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We ask your name, email, and a few details about your case to personalize the appeal.
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We compose a personalized appeal citing the exact federal regulations that apply to your case. A specialist reviews it.
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You sign. We fax and mail your appeal directly to your insurer. Then we follow up so you don't have to.
Denial: ER Visit Billing Error
“I was about to pay the bill and give up. FixMyDenial found the billing code error, cited the Prudent Layperson Standard, and got the entire $3,200 covered. I cried when I got the letter.”
Sarah M.
Houston, TX. Approved by Aetna.
$3,200
recovered
12 days
The only service that reads your denial, cites the exact federal law that applies, has a human review every letter, and delivers it to your insurer by fax and certified mail.
We read your actual letter, identify the denial code, and cite the specific federal regulation that applies to your situation. No fill-in-the-blank. Every sentence is written for your case.
Insurance law changes. Our team stays current on ERISA, ACA, and the latest CMS rules. Your letter cites the regulations that are in force today, not outdated boilerplate from 2020.
Every letter is verified by a specialist before it reaches your insurer. We catch errors. We verify the facts. Nothing goes out without a human having read it. Most services auto-send. We do not.
Sarah M.
Houston, TX
“Aetna denied my daughter's ER visit claiming it wasn't an emergency. $3,200 bill. FixMyDenial found they used the wrong billing code and cited the Prudent Layperson Standard. Appeal approved in 12 days. I cried when I got the letter.”
Aetna / Billing code error
James R.
Sacramento, CA
“My knee surgery was denied for 'not medically necessary' by UnitedHealthcare even though my orthopedic surgeon ordered it. The whole process took less than 10 minutes on my end. They handled everything, faxed it, mailed it. I just signed the letter.”
UnitedHealthcare / Medical necessity
Maria L.
Tampa, FL
“Blue Cross denied my son's MRI saying prior authorization wasn't obtained. My doctor's office confirmed they sent it. FixMyDenial found the documentation and got the denial overturned in 18 days. $5,400 saved.”
Blue Cross / Prior authorization
David K.
Phoenix, AZ
“Cigna denied my wife's therapy sessions under mental health. FixMyDenial cited the Mental Health Parity Act and showed Cigna was applying stricter limits on mental health than medical. Denial reversed. I wish I found this sooner.”
Cigna / Mental health parity
Linda P.
Denver, CO
“I had no idea you could even fight these. Humana denied my blood work as 'preventive care not covered.' Turns out it was coded wrong. FixMyDenial fixed it and I got the full refund. Best $49 I ever spent.”
Humana / Preventive care
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Everything you need to fight your denial
Free analysis first. No credit card required.
No. FixMyDenial is a document preparation service. We help you draft and submit appeal letters, but we do not provide legal counsel. For legal advice, consult a qualified attorney.
We handle the most common and winnable denial types: administrative errors (wrong billing codes, missing info, duplicate claims), prior authorization disputes, medical necessity denials, mental health and substance use disorder parity violations, and preventive care denials. Our free analysis tells you instantly whether your case qualifies.
If your appeal is unsuccessful, you still have options. Many states allow external review by an independent third party. We can advise you on next steps based on your specific situation.
The free analysis takes seconds. Once you pay, our team typically reviews and sends your appeal letter within 1-2 business days. Insurers then have 30 days to respond.
Yes. Your documents and personal information are encrypted and stored securely. We never sell your data to third parties. See our Terms of Service for full details.
Our free analysis will tell you upfront if your denial can be appealed. You only pay if we can help. If your denial type isn't one we handle yet, we'll let you know and suggest alternatives.
Millions of Americans have their claims denied every year. Most never fight back. Here is what you need to know.
Health insurance companies deny claims for dozens of reasons, ranging from simple billing errors to complex medical necessity disputes. The most common reasons include incorrect billing or procedure codes, missing prior authorization, services deemed "not medically necessary," and missing information on the claim form. According to KFF research, insurers on the ACA marketplace denied approximately 17% of in-network claims in 2023 alone.
Many of these denials are correctable. Administrative errors (wrong codes, duplicate submissions, missing data) account for the majority of denied claims, and they have the highest reversal rate when properly appealed.
Yes. Federal law gives every patient the right to appeal a denied claim. Under the Affordable Care Act (ACA), all health insurance plans must offer an internal appeals process. If the internal appeal fails, you have the right to an independent external review. These rights are codified under 45 CFR 147.136 for individual and group market plans, and 29 CFR 2560.503-1 for employer-sponsored ERISA plans.
For standard (post-service) claims, your insurer must respond to your appeal within 30 days. For pre-service denials, the deadline is 15 days. For urgent care situations, it is 72 hours.
Data from the Kaiser Family Foundation and Health Affairs shows that patients who file formal appeals win more often than most people expect. On the ACA marketplace, 44% of internal appeals result in the denial being overturned. For Medicare Advantage plans, the rate is even higher at 57% for standard claims and over 80% for prior authorization appeals.
The key factor is the quality of the appeal. A well-structured letter that cites the specific denial reason, references the applicable federal regulation, and includes supporting documentation is far more effective than a generic form letter or a phone call. This is exactly what FixMyDenial provides for every case.
A medical necessity denial means your insurer determined that a service, treatment, or procedure your doctor ordered was not required for your condition. This is one of the most common and frustrating types of denial because it puts the insurer's judgment against your doctor's.
Appealing a medical necessity denial requires demonstrating that the treatment was appropriate based on your clinical situation. The appeal should reference your medical records, your treating physician's first-hand clinical knowledge, and the applicable standard of care. Under ACA Section 2719, you also have the right to request an Independent Medical Review (IMR) if the internal appeal is denied.
An effective appeal letter should include: (1) the patient's identifying information and claim number, (2) the specific denial reason cited by the insurer, (3) a clear explanation of why the denial is incorrect, (4) references to the applicable federal or state regulations, (5) any supporting medical documentation, and (6) a formal request to reverse the denial.
The letter should be sent to the insurer's appeals department by certified mail and fax to create a documented paper trail. Sending only by email is not recommended, as many insurers do not accept email appeals or may claim they were not received.
If your mental health or substance use disorder treatment was denied, you may have additional protections under the Mental Health Parity and Addiction Equity Act (MHPAEA, 29 U.S.C. 1185a). This law requires insurers to cover mental health services at the same level as medical and surgical services. Your insurer cannot impose stricter limits, higher copays, or more restrictive prior authorization requirements on mental health benefits than on comparable medical benefits.
The Consolidated Appropriations Act of 2021 further strengthened these protections by requiring insurers to conduct and disclose comparative analyses of their non-quantitative treatment limitations (NQTLs) for mental health services. If your insurer cannot demonstrate compliance, the denial may be invalid.
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