Denied by UnitedHealth, Aetna, Cigna, Humana, or a Blue Cross plan? The ACA and ERISA guarantee your right to appeal. ClaimBack writes your professional appeal letter in 3 minutes.
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US insurance law gives you layered appeal rights — internal appeal, external review, and state regulator complaints. Here's how to use them.
Each US state has an Insurance Commissioner who regulates insurers operating in that state. For employer-sponsored plans covered by ERISA, the US Department of Labor oversees plan compliance. You can file complaints with your state commissioner at no cost. State commissioners have the power to investigate insurers and mandate claim payments.
Under the Affordable Care Act (ACA), you have the right to an internal appeal and then an independent external review. For urgent medical cases, external review must be completed within 72 hours. For standard reviews, the process takes up to 60 days. External reviewers are independent of your insurer and their decisions are binding. ERISA claimants win 70% of external reviews.
Internal appeal (ACA): Insurers must respond within 30 days for pre-service appeals and 60 days for post-service appeals. Urgent/concurrent care appeals: 72 hours. External review: 60 days for standard requests, 72 hours for expedited requests. ERISA plans: internal appeal decision within 60 days; external review within 60 days after that.
US government data shows that ERISA external review claimants win between 70% of cases. For ACA marketplace plans, external review success rates are similarly strong. The key differentiator is a well-structured appeal that cites the correct ACA provisions, ERISA sections, and medical necessity standards — which is exactly what ClaimBack generates.
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Each state has its own insurance regulator, appeal deadlines, and external review process. Find your state for specific guidance.
ClaimBack provides AI-assisted document drafting. We are not a law firm and do not provide legal advice.