Can You Appeal a Denied Insurance Claim? (Yes — Here's How)

Yes — you can appeal virtually any denied insurance claim, and appeals succeed far more often than most therapists expect. The reason claims stay denied is usually that nobody appealed, not that the appeal would have failed.

You have the right to appeal

Every insurer must offer an appeals process. For a therapy claim, that means you (the provider) or the patient can formally dispute the denial and require the payer to reconsider. Many denials are overturned simply because the appeal supplies the information the original claim lacked.

Levels of appeal

Most payers have multiple levels: (1) a first-level internal appeal (reconsideration), (2) a second-level internal appeal, and (3) for some plans, an external review by an independent third party. You can appeal a denied appeal — escalating to the next level.

What to include in a winning appeal

A strong appeal has: the corrected claim, a clear cover letter citing the specific denial code and why it's wrong, and supporting documentation — treatment plan, session notes proving medical necessity, and any relevant policy language (like mental health parity, which limits pre-auth requirements for outpatient therapy).

Fighting a health insurance denial that keeps coming back

If a payer denies for one reason, you fix it, and they deny for a new reason — that's a pattern worth escalating. Document each round, request a claims study from your provider-relations rep, and escalate to third-party review if internal appeals stall.