AI life tool · free to try · Pro unlimited

Insurance denial / prior auth appeal letter

Denied as not medically necessary? Draft a member internal appeal with claim numbers, facts, and a packet checklist plans actually review.

Research-informed structure Draft autosaved on this device Copy · print · download Not legal advice

1Mode + IDsPrior auth, medical necessity, OON, or quantity limit.

2Paste denial factsAuth #, reason phrase, clinician, deadline.

3Send packetLetter + denial + clinician note before the deadline.

1 · Mode 2 · Facts 3 · Letter

Build your letter

Draft saved

Letter mode

Prior auth denialOpen with member ID + auth number + service. Ask for reconsideration and a peer-to-peer between the plan medical director and your clinician. Attach the denial letter and clinic medical-necessity note.

Brief strength0%

Add a few key facts to unlock a strong draft.

Your name / business (optional)

Addressed to (optional)

Insurance plan

Member ID

Claim / auth number

Denial date

Drug or procedure

Denial reason (as written)

Prescribing clinician

Appeal deadline (if listed)

Situation details (facts, dates, amounts)

0 characters · Use real dates and amounts only — leave blanks if you do not know.

Shortcut Ctrl+Enter · Autosaves as you type

Not legal, medical, or financial advice. Review, personalize, and verify deadlines for your state and institution before sending. The AI will not invent account numbers, diagnoses, or statutes.

Your letter

Drafting with care…

Using structured facts — not generic filler

Your letter will appear here.

1. Pick a mode
2. Fill facts (or load an example)
3. Hit Generate

Appeal packet checklist

The letter is half the job. Tap items as you finish them — progress saves on this device.

Denial letter / EOB — all pages (deadline is usually on it)
Prescription, order, or pre-auth request copy
Clinician letter of medical necessity (strongest piece)
Chart notes showing failed alternatives / step therapy
Relevant imaging, labs, or specialist notes
Request peer-to-peer if the plan allows it
Calendar the internal appeal deadline; ask about external review rights if denied again

What actually works

Internal then external

Most plans require an internal appeal first. If that fails, many commercial plans allow independent external review under state or federal rules. Deadlines are short — put them on a calendar the day the denial arrives.

Clinician letter wins

Member letters set the frame; a medical-necessity letter from the treating clinician citing failed alternatives and clinical criteria is what medical directors weigh most heavily.

Quote the denial

Copy the plan’s exact denial reason. Then answer that reason point-by-point. Invented policy language hurts credibility.

Peer-to-peer

Ask for a peer-to-peer between the plan’s medical director and your specialist. Put the clinic phone number in the letter so scheduling is easy.

FAQ

Should my doctor write this?

Strongest packets include a clinician letter of medical necessity. This tool drafts your member appeal and reminds you what to request from the clinic.

What if the internal appeal fails?

Many plans allow external review. Your denial letter should explain rights and deadlines. Ask the plan or your state insurance department.

How long do I have?

Often 180 days for internal appeals on commercial plans — but always use the deadline printed on your notice. Some plans are shorter.

Is this medical or legal advice?

No. It is an educational draft. Follow your plan documents and your clinician’s recommendations.