Health insurance denied your claim? You have the legal right to appeal - and the tools and steps to do it without paying a lawyer or anyone else. Here is the full free playbook: your rights under the ACA, the deadlines that matter, the free AI tools that draft the letter, the state-by-state escalation paths, and the moments where it is worth bringing in a real lawyer.
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There are four tiers of genuinely free help for a denied health insurance claim. None of them require an account, a credit card, or a lawyer's retainer. Pick the tier that matches where you are in the process - and stack them, since they do different things.
You have a denial letter and need a credible first draft fast.
Counterclaim, Fight Health Insurance, and Counterforce Health all generate draft appeal letters at no cost. They save you 4 to 6 hours of writing and research. The trade-off is that you must read every line of the output, verify every citation, and adapt the draft to your specific situation before mailing. Treat the AI as a faster paralegal, not as a lawyer.
You want a regulator on your side or you suspect the insurer is breaking the law.
Every state runs a consumer-assistance line at its Department of Insurance (in California, the Department of Managed Health Care for HMOs). Their advocates can call insurers directly, escalate stalled appeals, and open formal complaints that often unstick a file in days rather than months. The catch is throughput: assistance is slower than an AI tool because a human is doing the work, and they cannot draft a custom medical-necessity argument for you.
Your denied claim is a Medicare, Medicare Advantage, or Medicaid claim.
Call 1-800-MEDICARE (1-800-633-4227) for Medicare and Medicare Advantage appeals, or your State Health Insurance Assistance Program (SHIP) for free one-on-one help. For Medicaid, every state runs a Medicaid Ombudsman or Fair Hearings office that handles appeals at no cost. Medicare and Medicaid appeals follow their own procedural ladders that differ from commercial ACA appeals, so use these channels instead of generic AI tools for the procedural steps.
Your case is complex, ERISA, or already through external review.
Legal Services Corporation funds civil legal aid offices in every state for income-qualified residents. Many university law schools also run free or low-cost health-law clinics where supervised students take real cases. These are best for self-funded ERISA disputes, mental-health-parity claims under MHPAEA, oncology cases, and any appeal you have already lost at the internal or external review stage.
The Affordable Care Act, codified at Section 2719 of the Public Health Service Act, guarantees every non-grandfathered health plan in the United States two layers of appeal at no cost to the member: an internal appeal handled by the insurer, and an external review handled by an Independent Review Organization whose decision is binding. State law and ERISA layer additional rights on top of this floor.
Internal appeal: 180 days from the denial notice
Most ACA-compliant plans give you 180 days (six months) from the date of the denial notice to file a written internal appeal. The insurer must complete its review within 30 days for pre-service denials and 60 days for post-service denials. For urgent cases that could seriously jeopardize your health, you have the right to an expedited appeal answered within 72 hours.
External review: 4 months after the final internal denial
If the internal appeal fails, you can request external review by an Independent Review Organization (IRO; called Independent Medical Review or IMR in California). You generally have 4 months after the final internal denial to file. The IRO's reviewing physician must be board-certified in the relevant specialty and free of any financial relationship with your insurer. Their decision is binding on the insurer, and the review is free to you.
Self-funded ERISA plans have their own carve-out
If your employer self-funds your coverage (the insurance company only administers the claims), state insurance law largely does not apply to you - federal ERISA does. You still have ACA appeal rights and federal external review, but ERISA's administrative-record rule means anything you do not put in your internal appeal can be excluded from any later federal lawsuit. Document everything in the internal appeal.
Medicare and Medicaid use separate appeal ladders
Medicare Advantage uses a five-level appeal process (reconsideration, ALJ hearing, Medicare Appeals Council, federal court). Original Medicare uses redetermination then reconsideration then ALJ then Council. Medicaid varies by state. Use 1-800-MEDICARE or your state Medicaid Fair Hearings office for the procedural steps; the legal arguments still come from the same law.
The process below applies to every commercial ACA-regulated health plan. Medicare, Medicare Advantage, and Medicaid use parallel ladders with different filing addresses; the substantive arguments below still apply.
If you only have a verbal denial or a confusing bill, call your insurer's member-services line and request a written denial notice and a copy of the most recent Explanation of Benefits (EOB). Both documents must be reissued on request. The written denial is the document the appeal clock runs from, and the EOB is the document of record for the dollar amounts you are contesting. Without one of these in hand you do not yet have a formal denial to appeal.
Pull together the denial letter, the EOB, your insurer's published clinical coverage policy for the service, your treating physician's notes from the visit, any prior-authorization correspondence, the Summary of Benefits and Coverage (SBC), and the relevant pages of your Evidence of Coverage (EOC). If you can get a letter of medical necessity from your treating physician at this stage, ask. A doctor's letter that quotes peer-reviewed studies and ties them back to your specific diagnosis is the single most persuasive document an appeal can carry.
Find the alphanumeric code on your EOB or denial letter (CO-50, CO-11, PR-1, CO-97, and so on). The code tells you what argument the insurer is making and which set of laws applies. Counterclaim publishes a free guide for every common code at /denial-codes. Read the guide for your code before you draft anything; the strategy for a CO-50 medical-necessity denial is very different from the strategy for a CO-11 prior-authorization or a CO-55 experimental denial.
You have three free options: write the letter yourself using the structure described below, run your denial through an AI drafting tool (Counterclaim, Fight Health Insurance, or Counterforce Health), or ask a free patient advocate or SHIP counselor to help. A solid letter has three short paragraphs: who you are and what claim is being contested; the medical and legal basis for the appeal with specific citations; and the requested relief and deadline for the insurer's response. Keep it under three pages plus exhibits.
Whether you wrote the letter yourself or used an AI tool, this step is non-negotiable. Look up every statute or regulation cited and confirm it exists and says what the letter claims. Confirm the deadline on your letter matches the deadline on your insurer's denial notice. Confirm every patient name, member ID, claim number, date of service, CPT code, ICD-10 code, and dollar amount matches your actual EOB and physician records. AI tools can hallucinate fake citations or apply the wrong state's law; sending an unverified draft can hurt your appeal more than not appealing at all.
Mail the signed letter to the appeals address on your denial notice (not the general claims address) using USPS Certified Mail, Return Receipt Requested. The Certified Mail receipt is your proof of filing date if there is ever a dispute about whether the deadline was met. If your insurer also accepts secure fax or member-portal upload, do that in addition to certified mail, not instead of it.
Insurers must answer a standard internal appeal within 30 days for pre-service denials and 60 days for post-service denials under ACA rules. If your case is urgent (waiting could seriously jeopardize your health), request an expedited internal appeal in writing; the response window drops to 72 hours. Mark the deadlines on a calendar. If the insurer misses a deadline, that is itself grounds for escalating to external review under federal regulation.
If the internal appeal fails, you have the right under the Affordable Care Act to a free external review by an Independent Review Organization (IRO; called Independent Medical Review or IMR in California). The IRO is independent of the insurer, its decision is binding on the insurer, and the review is free to you in all states. The deadline to request external review is generally 4 months after the final internal denial. External reviewers overturn insurer decisions in roughly 39 to 47 percent of cases.
If you have lost both internal appeal and external review, file a formal complaint with your state Department of Insurance (or, in California, the Department of Managed Health Care). For self-funded ERISA plans, the equivalent is the federal Department of Labor's Employee Benefits Security Administration (EBSA) at 1-866-444-3272. Regulators can investigate, fine insurers for procedural violations, and sometimes secure payment outside the appeal system. This is also the point at which a consultation with a healthcare attorney becomes worth the money.
Internal-appeal windows are governed by the ACA floor of 180 days, and most states adopt that floor. External-review windows vary more substantially. The table below covers 15 of the most populous states; for any state, the canonical source is your specific denial notice and your state Department of Insurance consumer page.
| State | Internal appeal | External review | File a complaint |
|---|---|---|---|
| California | 180 days | 4 months (180 days for IMR) | Department of Insurance / DMHC |
| Texas | 180 days | 4 months | Texas Department of Insurance |
| New York | 180 days | 4 months | Department of Financial Services |
| Florida | 180 days | 4 months | Office of Insurance Regulation |
| Illinois | 180 days | 4 months | Department of Insurance |
| Pennsylvania | 180 days | 4 months | Insurance Department |
| Ohio | 180 days | 180 days | Department of Insurance |
| Georgia | 180 days | 60 days | Office of Commissioner of Insurance |
| North Carolina | 180 days | 120 days | Department of Insurance |
| Michigan | 180 days | 127 days | Department of Insurance and Financial Services |
| New Jersey | 180 days | 4 months | Department of Banking and Insurance |
| Virginia | 180 days | 120 days | Bureau of Insurance |
| Washington | 180 days | 180 days | Office of the Insurance Commissioner |
| Massachusetts | 180 days | 4 months | Division of Insurance |
| Arizona | 180 days | 4 months | Department of Insurance and Financial Institutions |
Deadlines reflect 2026 published guidance and are starting points only. The deadline printed on your specific denial notice controls. Self-funded ERISA plans follow federal external review rules administered by the Department of Labor's EBSA at 1-866-444-3272.
Three free AI tools currently dominate this space. Each is good at slightly different things. Honest takeaway: try them all on the same denial, pick the draft you trust most, and verify every line yourself before sending. Do not blind-send any AI output. For a deeper feature-by-feature comparison see /compare.
When to pick it: Best when your denial has real legal stakes (over $5,000) or you want the adversary critique. Slower than a single-pass tool because four agents have to agree before you see output.
When to pick it: Best for a fast first draft you intend to verify and edit yourself. Less state-law specificity; you do more of the legal lookup work.
When to pick it: Best if you are new to insurance terminology and want guided data entry. Slower to first draft because intake comes before generation.
AI tools and free advocates handle the broad middle of denial cases well. There are categories where the math, the procedural traps, or the medical complexity tip the balance toward at least a free initial consultation with a healthcare attorney before you mail anything:
Read the longer "when to consult" list and referral starting points on our disclaimer page.
Bookmark these. They are the canonical free-help directories for US health insurance disputes:
Upload your denial letter on the home page. Our 5-agent AI pipeline will identify the denial reason, cite state and federal law, and draft a print-ready appeal letter in under 90 seconds. Free during launch, no account required.
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