Your ACA plan, ERISA employer plan, or Medicare Advantage gives you clear federal rights to appeal. External reviewers overturn denials 40% of the time — and it's completely free. The insurer counts on you not knowing this.
ClaimBack generates ACA-compliant appeal letters citing ERISA, ACA, and MHPAEA — in 3 minutes.
US health insurance has four main types — each with different rules for appeals.
Full ACA appeal rights including external review. File through healthcare.gov or your state exchange.
ACA Appeal Guide →ERISA governs your rights. Strict deadlines — typically 60-180 days per plan docs. Must exhaust internal appeals.
ERISA Appeal Guide →Federal Medicare appeal process: redetermination → QIC reconsideration → ALJ hearing → Medicare Appeals Council.
Medicare Appeal Guide →State fair hearing rights apply. You can request a hearing within 90 days of any action — including denials.
Medicaid Appeal Guide →ACA, ERISA, MHPAEA, and state law combine to give Americans powerful — but time-limited — appeal rights.
Every US state has its own insurance department that licenses and regulates health insurers. They handle consumer complaints, investigate bad faith denials, and can order insurers to reverse wrongful decisions. For ACA marketplace and state-regulated plans, your state department is the first escalation point.
Learn more →Under the Affordable Care Act, you have the right to an independent external review of any denied claim after exhausting internal appeals. The external reviewer's decision is binding on the insurer. This applies to ACA marketplace plans and most commercial plans.
Learn more →If your insurance is through your employer, ERISA (Employee Retirement Income Security Act) governs your appeal rights. You must exhaust the plan's internal appeal process before suing in federal court. ERISA claims have strict 60-180 day notice deadlines — act fast.
Learn more →Under the ACA, you have the right to a written explanation of any denial within 24 hours for urgent care or 3 business days for standard care. The denial must cite the specific policy provision, coverage guideline, or medical necessity standard used.
After a final internal appeal denial, you have 4 months to request an independent external review. External reviewers overturn insurer denials in approximately 40% of cases nationally — a rate insurers don't advertise.
MHPAEA (Mental Health Parity and Addiction Equity Act) requires insurers to cover mental health and substance use treatment on terms no more restrictive than medical/surgical coverage. Mental health denials frequently violate MHPAEA.
For Medicare Advantage denials, you have the right to a fast appeal (within 72 hours for urgent cases). Medicare has its own multi-level appeal process: redetermination → reconsideration → ALJ → Medicare Appeals Council → federal court.
Each state has its own insurance department and external review processes. Find yours:
Aetna denied NICU coverage for your baby? You have the right to appeal. 40-60% of appeals succeed. Free appeal letter in 3 minutes — citing ACA newborn coverage rules and Aetna's own clinical criteria.
Read guide →Aetna Medicare Advantage denied your claim? Here's how to use Aetna's MA appeal process and escalate through the CMS appeals ladder.
Read guide →BCBS Medicare Advantage plan denied your claim? Blue Cross plans vary by state but all follow federal MA appeal rules. Here's how to appeal.
Read guide →Blue Cross Blue Shield denied your surgical procedure as not medically necessary? Here's how to appeal BCBS surgery denials and win.
Read guide →Cigna Medicare Advantage denied your prior authorization or claim? Here's how to challenge Cigna MA denials through the federal appeals process.
Read guide →Cigna denied your surgery as not medically necessary or not prior authorized? Surgical denials are among the most successfully appealed. Here's how to fight back.
Read guide →Cigna denied your health insurance claim in Thailand? Cigna is one of the largest international health insurers in Thailand. Here's how to appeal.
Read guide →Humana Medicare Advantage denied your claim or prior authorization? Humana is the second-largest MA insurer. Here's how to appeal through Humana and CMS.
Read guide →Humana denied your surgical procedure or prior authorization for surgery? Here's how to challenge Humana surgery denials through appeals and external review.
Read guide →ClaimBack generates ACA-compliant appeal letters citing ERISA, ACA, and MHPAEA in 3 minutes.
Start My Free Appeal →Takes 3 minutes · No login required · External review ready
ClaimBack provides AI-assisted document drafting. We are not a law firm and do not provide legal advice. For complex ERISA litigation, consult a licensed attorney in your state.