Verified 2026-09-15

The form you need, the address it goes to, the deadline that applies.

Appealing a health-insurance denial is mostly paperwork sent to the right place before a date. This site lists the official form for each program, links straight to the agency that issues it, and cites the rule the deadline comes from. Nothing is hosted here except the directory.

Federal programs

Original Medicare (Parts A and B) →
3 forms · 42 CFR Part 405, Subpart I
Medicare Advantage (Part C) →
3 forms · 42 CFR Part 422, Subpart M
Medicare Part D (drug coverage) →
3 forms · 42 CFR Part 423, Subpart M; exceptions under 42 CFR 423.578
Federal external review (HHS-administered states and self-funded employer plans) →
2 forms · 45 CFR 147.136(d); 29 CFR 2560.503-1 for ERISA plans
TRICARE →
1 form · 32 CFR 199.10

Employer, individual and Marketplace plans: your state regulator

For insured plans the external review runs through the state (or the federal process where the state has none). Self-funded employer plans go to the federal process and the U.S. Department of Labor. Pick your state for the regulator, the review system and the published reversal rate.

Letters and tools

Claim-file and criteria request letter: Ask the plan for the complete claim file and the specific criteria it relied on, free of charge (29 CFR 2560.503-1(h)(2)(iii), (m)(8); 45 CFR 147.136)
Appeal letter generator with verified citations: A first-level internal appeal built to the denial reason, with the plan-type rule cited
Appeal letter templates by denial type: Fillable letters for medical necessity, prior authorization, step therapy, out-of-network and more
Appeal deadline calculator: The federal floor for each plan type, cited; the letter controls
Denial letter decoder: What the wording on the letter means and what to ask for

Not sure which form, or whether the denial can be appealed at all?

Upload the letter at apellica.com/scan. It is read on your device first, then a reviewer answers in writing: appealable or not, which rule, by when. Free; Apellica prepares and files the appeal only if you ask, at $0 upfront.