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Appeal Letter: Chemotherapy Denied by Insurance

Use this template when your insurer denied chemotherapy coverage as experimental or investigational. Cancer treatment denials are among the most critical appeals and have strong legal protections.

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Key Arguments to Make

  • ✓The chemotherapy regimen is FDA-approved and listed in NCCN Clinical Practice Guidelines as standard of care
  • ✓Off-label use of FDA-approved drugs is standard oncology practice and must be covered under most state laws
  • ✓Denial of chemotherapy for a cancer diagnosis creates immediate and serious risk of harm
  • ✓The insurer's definition of 'experimental' is inconsistent with established oncology standards

Appeal Letter Template

Customize the sections below with your personal details. Replace text in [brackets] with your information.

Sample Appeal Letter — ChemotherapyPersonalize This Letter →
To: [Insurance Company Name], Appeals Department
Re: Appeal of Claim Denial — [Your Name] — Member ID: [Member ID]
Date: [Today's Date]
Opening

I am writing to urgently appeal the denial of coverage for [Chemotherapy Regimen] for treatment of [Cancer Diagnosis]. The denial reference number is [Denial Reference]. Given the serious nature of my diagnosis, I request expedited review.

Medical Necessity Statement

I have been diagnosed with [Cancer Type, Stage]. My oncologist, [Provider Name], has prescribed [Chemotherapy Regimen] as the recommended standard-of-care treatment based on [clinical evidence].

Clinical Support

This regimen is listed in the NCCN Clinical Practice Guidelines for [Cancer Type] as Category [1/2A] evidence. It is [FDA-approved / FDA-approved off-label as standard oncology practice]. Denial of this treatment is inconsistent with NCCN standards that most insurers incorporate by reference in their clinical criteria.

Closing

Denial of chemotherapy for active cancer creates immediate risk of disease progression and harm. I request reversal within the expedited review timeline (72 hours for urgent care). I am prepared to pursue Independent External Review and state insurance department complaint if my appeal is denied.

Sincerely,
[Your Name]
[Phone] · [Email]

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