Appeal guides & free letter templates
UPDATED JULY 2026 · U.S. PLANS · FREE TO USE
Find your denial reason below. Each guide explains what the denial actually means, your deadlines, the evidence that wins, and includes a free copy-paste appeal letter template. About 4 in 10 appeals succeed — the paperwork just has to be done right.
How to appeal a denial, step by step
The full process: internal appeal → external review, with every deadline.
Free templateAppeal letter template (all purposes)
A solid general-purpose letter with instructions for filling every blank.
Most common"Not medically necessary"
The most frequent denial reason — and one of the most beatable.
Pre-servicePrior authorization denied
When approval is refused before treatment — including urgent cases.
MedicationsStep therapy / "fail first"
They want you to fail cheaper drugs first. Your history may already qualify.
MedicationsDrug not on formulary
How to request a formulary exception with your prescriber's support.
Behavioral healthTherapy / mental health denial
Federal parity law limits how much stricter mental health rules can be than medical ones.
NetworksOut-of-network denial
Network-gap exceptions, surprise-billing protections, and emergencies.
EmergenciesER visit denied
"Not an emergency"? Coverage is judged by your symptoms at the door — not the final diagnosis.
Coverage"Experimental / investigational"
When the treatment is standard care and their policy just lags the evidence.
Second chanceExternal review, explained
The independent, binding review most people never use — and should.
CaliforniaAppeal a denial in California (DMHC IMR)
Free Independent Medical Review with a strong track record — if your plan qualifies.
ReferenceDenial codes, decoded
What CO-50, CO-45, CO-197, PR-204 and the rest mean — and who fixes each.
Free toolAppeal deadline calculator
Enter your denial date, get estimated deadlines plus calendar reminders.
DataDenial rates: the federal data
19% of in-network claims denied; fewer than 1% appealed. Sourced numbers.
DrugsGLP-1 denied: exclusion or prior auth?
Ozempic, Wegovy, Mounjaro, Zepbound — the two denials need different appeals.
ImagingMRI or CT scan denied?
What the reviewer is actually asking, and why the peer-to-peer comes first.
Your denial letter has the answers. Upload it.
GetMyYes reads the actual letter, identifies the denial type, and drafts the whole packet around your case: appeal letter, evidence checklist, doctor letter request, call script, deadlines. Free preview before paying anything.
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