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You will not miss your deadline.
Type the code from your denial. We'll translate it, build your appeal — and watch the clock so you don't have to.
1 · How do you get your insurance?
This decides your deadlines — and they differ a lot. Medicare Advantage gives you 65 days; most other coverage gives you 180.
2 · Find your reason code
It's on your Explanation of Benefits (EOB), usually labeled "reason code," "adjustment code," or "CO/PR-##."
3 · The details (kept on your device)
You need the fast lane — not the mail.
Because this is about care you still need, don't start with a letter. Call the member-services number on your insurance card today and say:
When your health is at risk, they must decide in 72 hours or less. Ask your doctor to call too — a physician's urgency request is hard to ignore. Use the letter below as your written follow-up, not your first move.
Your odds of fixing this
Your clock
Build your case
Your appeal letter
You can edit the letter directly above. It sends under your name — make sure every fact is true.
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Your appeals, and their clocks.
Five minutes to understand the fight
Insurance denials, explained like a friend would.
No jargon. Just what happened, what your rights are, and what to do next.
Where do I find my denial code?
After a claim is denied, your insurer mails (or posts online) an Explanation of Benefits — an "EOB." It looks like a bill, but it isn't one. The code is usually in a column called "reason code," "adjustment code," or "remark":
| Service | Billed | Plan paid | You may owe | Reason code |
|---|---|---|---|---|
| MRI, lower back | $2,340.00 | $0.00 | $2,340.00 | CO-50 ← |
The letters before the number matter too: PR means "patient responsibility" (they say you owe it). CO means "contractual obligation" — in-network, the provider usually has to absorb those, not you. If a hospital bills you for a CO-coded denial, question it.
The four steps of fighting back
1 · Decode. Find the reason code and understand what they're actually claiming. (That's the free tool here.)
2 · Internal appeal. A letter to your insurer, within 180 days, with evidence. They must answer — 30 days for care you haven't gotten yet, 60 days for care you already received.
3 · External review. If they say no again, you have 4 months to demand an independent doctor — who doesn't work for them — decide. Their decision is binding on the insurer.
4 · Escalate. Your state insurance commissioner takes complaints, and they're free. Insurers hate commissioner complaints.
Your rights (the ones they don't advertise)
Appealing is free and it is your legal right under the Affordable Care Act.
They cannot cancel you or raise your rates for appealing. Retaliation is illegal.
You can demand the reviewer's credentials — and the exact plan language and clinical criteria behind the denial. In writing.
Emergencies can't require prior authorization. If a "prudent layperson" would have thought it was an emergency, it was one.
Someone can fight for you. A signed "authorized representative" form lets a family member, advocate, or a service like AppealClock deal with the insurer directly on your behalf.
Words they use, translated
- EOB (Explanation of Benefits)
- The "not a bill" document that says what they paid and what they refused.
- Medical necessity
- Their opinion of whether you needed the care. Your doctor's documented opinion is the counter-evidence.
- Prior authorization
- Permission the insurer wanted before the care happened. Usually the provider's job to get.
- Internal appeal
- Round one: asking the insurer to reverse itself. About 4 in 10 succeed.
- External review
- Round two: an independent doctor decides, and the insurer is bound by it.
- Authorized representative
- A person or service you legally appoint, in writing, to fight the insurer for you.
The whole ladder — a "no" is never the last rung
Most people — and most appeal services — stop after the first "no." But every coverage type has a full ladder of appeals, and the higher you climb, the less the insurer's own opinion matters. Deadlines below start from each decision notice.
Employer & marketplace plans: internal appeal (180 days) → independent external review (4 months) — the reviewer's decision binds the insurer → state insurance commissioner complaint (anytime, free, and insurers genuinely dislike them).
Medicare Advantage: plan reconsideration (65 days) → if upheld, your case is automatically forwarded to the Independent Review Entity → Administrative Law Judge hearing (60 days, claims of roughly $200+) → Medicare Appeals Council → federal court (roughly $1,960+). Five rungs, and most people never learn rung two is automatic.
Original Medicare: redetermination (120 days) → reconsideration by a Qualified Independent Contractor (180 days) → the same ALJ → Council → court ladder.
Medicaid: state fair hearing (usually 90 days — check your notice) → state appeal or judicial review. File fast and your benefits can sometimes continue while you fight.
The pattern: insurers win by making each rung feel like the end. It never is — and your tracker's status menu now follows every rung, so you always know where you stand and what's next.
The bill, collections, and your credit — while you fight
Don't rush to pay a bill you're appealing. Paying can be treated as accepting the charge. Instead, call the provider's billing office, say "this claim is under appeal with my insurer," and ask them to pause the account. Most will — they'd rather the insurer pay than chase you.
If it goes to collections anyway: send the collector a written dispute within 30 days of their first notice — they must pause and verify the debt. An appealed insurance claim is a textbook disputed debt.
Your credit is safer than you think. Paid medical collections come off credit reports, unpaid medical debt under $500 doesn't appear at all, and there's a 365-day wait before any medical debt can be reported — usually longer than your whole appeal.
If the bill is huge: ask the hospital for their financial assistance policy — nonprofit hospitals are legally required to have one, and many reduce or forgive bills based on income, even for the insured.
What happens after you win
1. The insurer reprocesses the claim — watch for a corrected EOB in 2–4 weeks.
2. Confirm the provider got paid and zeroed your balance. Call and ask for a $0 statement in writing.
3. If you already paid anything toward the denied amount, request the refund explicitly — it is not always automatic.
4. If a collector was involved, send them the corrected EOB and demand the account be closed and any credit reporting withdrawn.
Who's behind AppealClock — and who to call besides us
AppealClock is an independent tool — not owned by, paid by, or affiliated with any insurance company. It makes money one way: the flat-fee services on the "Go further" page. Never a percentage of your claim. Questions, corrections, or a denial we got wrong? Write us: hello@appealclock.com — a human reads every message.
Free human help exists too, and we'd rather you use it than get stuck: your state's Consumer Assistance Program (find it at HealthCare.gov's CAP directory), your state insurance commissioner, and for Medicare, your local SHIP counselor (1-877-839-2675).
Honest answers to scary questions
"Will they retaliate if I appeal?" No — it's illegal, and appeals are processed by a department that exists to process them.
"Do I need a lawyer?" For internal appeals and external review: no. The process was designed for consumers. Lawyers matter for lawsuits, which come later, rarely.
"Is it worth it for a small bill?" The letter takes minutes with this tool. For $200+, almost always worth it. And every appeal makes reflexive denials more expensive for them.
"I missed the 180 days." Ask anyway — some plans and states allow late appeals for good cause, and billing errors can restart clocks. Then call your state insurance commissioner.
Do it yourself free — or hand it to us
Three ways to fight. One is always free.
Flat prices, never a percentage of your claim. If we take a cut of your medical money, our incentives rot — so we don't.
- Translate any denial code
- Honest odds & strategy
- Ready-to-send appeal letter
- Deadline tracking in your browser
- Everything in Learn
- AI reads your actual denial letter & doctor's notes
- Flags miscoding and missing evidence
- Rewrites your letter citing your specifics
- Evidence checklist tailored to your case
- Documents processed, never stored
- Everything in Deep Review
- Printed & sent certified mail with delivery proof
- You sign an authorized-representative form — then we deal with the insurer directly
- Written follow-ups until they answer
- If denied again: we file your external review
- If your appeal is finally denied at every level, the $100 comes back automatically. No request, no forms. (Our win and refund rates will be published on this page.)
For billers, practices & patient advocates
You fight denials all day. We're building a professional tier: bulk decode, appeal generation at scale, deadline dashboards for your whole caseload, and an embeddable decoder for your site. Tell us you want it and shape what it becomes.