Insured plan
An insurance company pays your claims. Your state’s insurance department oversees it, and an independent review run by your state can overturn a wrong denial.
For anyone whose health insurance claim was denied
Find out where your appeal goes, and how long you have.
Search your employer. We read its health plan’s public filing with the U.S. Department of Labor and tell you who can overrule the denial, where to send your appeal and every deadline.
Try
- 62,188employer health plans
- U.S. Dept. of Laborpublic filings, plan year 2024
- Freeno account, no tracking
Why it matters
One question decides who can overrule your insurer
Self-funded plan
Your employer pays claims from its own money; the insurer on your card often just processes them. Federal law applies, the U.S. Department of Labor enforces it, and an independent reviewer the plan hires decides.
How it works
From denial letter to a plan of action in a minute
- 1
Find your employer
Every employer health plan with 100 or more people files a public report each year.
- 2
See which rules apply
We read the insurance contracts and claims administrators in that report, and show our evidence.
- 3
Get your appeal route
Who to write to, the exact dates you must meet, and who will help for free.
Not through a private employer?
Pick the coverage you have
- Individual plan (state-regulated)Plans you buy yourself are regulated by your state.
- Public-employer planGovernment plans don't file Form 5500 and aren't covered by ERISA.
- Federal employee planDisputes go to the carrier first, then to the Office of Personnel Management (OPM).
- Church planChurch plans usually aren't covered by ERISA.
- Small-employer planMost small plans don't file Form 5500.
- Original MedicareMedicare has its own five-level appeal process.
- Medicare Advantage planAppeal to the plan first.
- Medicaid / CHIPAppeal to your Medicaid health plan, then ask the state for a fair hearing.
Questions
Good to know
Why does it matter if my plan is insured or self-funded?
It decides which rules protect you. An insured plan is regulated by your state: the state insurance department can help, and an independent review run by your state can overturn a wrong denial. A self-funded plan is governed by federal law (ERISA): the U.S. Department of Labor enforces the rules, and an independent reviewer the plan hires decides external appeals.
Where does this information come from?
Every employer health plan with 100 or more participants files a public report, Form 5500, with the U.S. Department of Labor each year. We read the insurance contracts (Schedule A) and the companies paid to process claims (Schedule C) in the plan year 2024 filings.
How accurate is it?
We checked our reading against published plan documents from 24 large employers. When the filing alone can’t tell which kind of coverage you have, we ask one question about your insurance card instead of guessing, and every page shows the evidence we used.
My employer isn’t listed. What now?
Small employers, government employers and churches usually don’t file. Pick the situation that fits you on the home page: each one has its own appeal route and deadlines.
Is this legal or medical advice?
No. It’s general information about the appeal process, deadlines and where to get free help. For advice about your situation, the free help lines on each page are a good start.
Does it cost anything?
No. There’s no account and nothing to install. We don’t use tracking or advertising cookies.
Coming next
Get help writing the appeal letter
We’re building a tool that drafts your appeal from the denial letter and keeps track of every deadline. Leave your email and we’ll send one note when it’s ready.