Your insurance said no and you're not sure why

By Andrew at Axion Labs · August 19, 2026, updated September 5, 2026

That is the most common situation there is, not a sign you missed something. The biggest single category in the federal data is denials the insurer never properly explained: 28,113,631 of them. You are not being slow. They were not being clear.

Take a breath, nothing is lost yet. You almost certainly have 180 days from the date on that letter to appeal, and appealing costs nothing. Whatever else is going on, you probably have months, not days. Check your exact date →

Find your denial in your own words

Get the letter or the Explanation of Benefits in front of you. Work down this list and click the first one that sounds like yours, the wording on your letter will be somewhere in it.

Does the letter use the words “medically necessary”, “not medically appropriate”, or “criteria not met”? If yes → They say you didn't need the treatment. Your doctor says you did.

Does it mention “out of network”, “non-participating”, or a provider you did not choose, or was this an emergency? If yes → You got a bill from a doctor you never chose.

Does it call the treatment “experimental”, “investigational” or “unproven”? If yes → They called your treatment “experimental.” Your specialist recommended it.

Does it say the service is “excluded” or “not a covered benefit” under your plan? If yes → They say your plan simply doesn't cover this.

Does it mention a missing “referral” or “prior authorization”? If yes → You didn't know you needed a referral first.

Does it say you have reached a “limit”, “maximum”, or used up your visits? If yes → They say you've used up your sessions. You still need them.

Does it say you were not eligible, not enrolled, or not covered on the date you were treated? If yes → They say you weren't covered that day. You were.

Does it mention missing information, a coding problem, a duplicate, or filing too late? If yes → They denied it over paperwork. Not over your care.

None of them fit, or the letter is vague? Then your denial is in the largest group of all, and the answer is the same for everyone in it: make them tell you the actual reason. You have a legal right to the specific reason and the plan provision behind it, and to a free copy of the file they used to decide. Until they say what they actually decided, there is nothing to argue with, and that request is the single most useful thing you can send.

What is true no matter which denial you have

A denial is not a final decision. It is the first decision, made quickly, often by someone who never examined you.
You get two appeals, and both are free. One inside the insurer, then one to an independent reviewer who does not work for them and whose decision they must accept.
The second one is the one nearly everybody skips, 1 in 14,369. Only 1 in 14,369 denials ever reaches independent review, and 32.8% of those that do are overturned.
You can hand it to someone else. Your doctor or a family member can file on your behalf with your written permission. You do not have to do this while you are ill.

How the appeal actually works → · See all denial reasons →

Work out your two deadlines

The federal timeframes: 180 days from the date on the denial notice to file the internal appeal, then 4 months from the final internal denial to request independent external review. Put your date in and get the actual calendar dates, with the days remaining.

Date on your denial notice Which denial is this?

Runs entirely in your browser, the date you type is never sent to us and never stored. Open the full calculator →

If you are here it is because the letter did not explain itself, and that is the normal experience rather than a failure of yours to read it properly. Work down the list, pick the one that sounds closest, and start there, you can change your mind later without losing anything. None of it costs money and none of it needs you to understand insurance. If nothing fits, send me the wording with your name and claim number taken out and I will tell you which one you are looking at.

, Andrew at Axion Labs · hello@getaxionlabs.com

Get my Appeal Kit, $29

Everything you need for a denial you don't understand yet: your two deadlines, the argument that fits your denial reason, the letters, the clinician brief, and the external review request. One payment. No subscription. No cut of your claim. Opens on screen the moment you pay. 14-day refund, no questions, one email to hello@getaxionlabs.com.

Where these numbers come from

Counts: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain. Rights and timeframes: 29 CFR 2560.503-1 (180 days, and your free right to the claim file) and 45 CFR 147.136 (4 months, and what qualifies), explained at HealthCare.gov. Expedited review is decided in about 72 hours under both sections.

Reading either regulation from a script rather than a browser: eCFR answers automated fetches with a challenge page, so the same two sections are mirrored as government PDFs at govinfo.gov (29 CFR 2560.503-1) and govinfo.gov (45 CFR 147.136).

This page presents federal statistics and a general description of appeal rights created by federal law. It is not legal, medical, or insurance advice, and no outcome is guaranteed. Your denial letter and plan documents govern your specific case. Free help is available from your state's Consumer Assistance Program and from the federal Marketplace at HealthCare.gov.