Appealing a Health Insurance Denial: A Practical Guide

Summary. This guide runs an appeal from the day the denial arrives through external review and into court: the threshold question, the claim file, reading the criteria, the medical necessity letter, the internal appeal, external review, regulatory complaints, and the record rule that makes the internal appeal decisive.

For the law — the ERISA/insured distinction, Firestone deference, Glenn, Nord, and the federal protections — see Health Insurance Denials and Appeals. This guide is what to do, in order.

Two things to know before starting. A substantial share of appealed denials are overturned, and a substantial share of denials are never appealed. And if your plan is a self-funded ERISA plan, the internal appeal is your only chance to build a record — a court will generally review only what the plan had in front of it.

Stage 1: Day one — three questions

1. What does the letter actually say? Find the specific reason — not medically necessary, experimental, not a covered benefit, out of network, no prior authorization, not eligible. Each points to a different response, and they are frequently mischaracterized.

2. What is the deadline? It is stated in the letter. Generally 180 days for the internal appeal. Write it on a calendar today.

3. Is the plan self-funded or fully insured? Ask HR in writing: "Is our health plan self-funded or fully insured?" Or read the Summary Plan Description. This determines what law applies, what remedies exist, whether state mandates help you, and how a court will review the decision.

Stage 2: Request the claim file — today

This is the single most productive step, it is free, and almost nobody takes it.

Re: Claim [number] · Member [ID] · Denial dated [date] — Request for documents under 29 C.F.R. § 2560.503-1

I am appealing the above denial. Pursuant to the claims procedure regulation, I request, free of charge, copies of all documents, records, and other information relevant to the claim, including specifically:

1. The complete claim file.
2. All internal rules, guidelines, protocols, and medical necessity criteria relied upon in making this determination.
3. The identity and professional credentials, including board certification and specialty, of every individual who reviewed this claim, and whether each is an employee, a contractor, or a consultant.
4. Any medical or vocational expert advice obtained, whether or not relied upon.
5. The specific plan provisions on which the denial is based.
6. The Summary Plan Description and the plan document.
7. All notes, correspondence, and system entries concerning this claim.

Please provide these within 30 days. My appeal deadline is [date], and I request that the deadline be extended by the time taken to produce these documents.

Why each item matters. The criteria tell you exactly what the reviewer was checking. The reviewer's credentials tell you whether a specialist decided a specialist question. The plan document tells you whether the exclusion says what the letter claims.

Stage 3: Read the criteria against your own records

Print the criteria. Print your records. Go through line by line.

Mark, for each criterion: does the record show it, and where — the date, the document, the page. Most criteria sets are checklists of clinical findings, and a substantial share of denials fail because the reviewer applied criteria the patient actually satisfies and nobody checked.

Then look for the reviewer's specialty. A denial of a specialized treatment by a physician in an unrelated field is a substantive point, and many states require specialty matching.

And read the plan language. Where the denial rests on an exclusion, read the exclusion narrowly and look for another provision that covers the service. "Not a covered benefit" is a contract dispute, not a clinical one.

Stage 4: The letter of medical necessity

The most common mistake is a general letter saying the treatment is appropriate. That is not what wins.

Give your physician the denial letter and the criteria, and ask for a letter with this structure:

"I am writing regarding the denial dated [date] of [service] for [patient]. The stated reasons were: (1) [quote]; (2) [quote]. I address each below."

For each stated ground: the plan's criterion, quoted; the clinical finding that satisfies it; where in the record it appears, by date.

Treatment history: what was tried, for how long, at what dose, and why it failed or was contraindicated. This is what defeats a step therapy or "less intensive alternative" denial.

Consequence of denial: what happens clinically if this is not done, specifically.

Literature: cited, with the relevant conclusion stated.

Response to the reviewer: where the denial rests on a named reviewer's opinion, answer that reasoning directly.

Ask for a peer-to-peer review. Most plans offer one — a call between your physician and the plan's reviewer. It resolves a meaningful share of denials before a formal appeal, and it takes twenty minutes of the physician's time.

Stage 5: File the internal appeal

In writing, always. A phone call is not an appeal.

Structure it:

1. Identification — member, claim number, date of service, provider, denial date.
2. What you are appealing and what you want — one sentence.
3. Each stated reason, answered, in the plan's own words, with the evidence.
4. The plan language that covers the service, quoted.
5. Enclosures, listed.
6. A statement preserving everything: "I am submitting the following in support of my appeal and request that all of it be included in the administrative record."

Enclose: the physician's letter, the relevant records with the supporting entries flagged, the literature, and anything else you might ever want a judge to see.

Send it traceably and keep proof of delivery.

Ask for an expedited appeal if delay would seriously jeopardize life, health, or the ability to regain maximum function — decided in 72 hours, and it may run concurrently with expedited external review.

Know the plan's deadlines: 72 hours (urgent), 30 days (pre-service), 60 days (post-service). If the plan misses them, you may generally treat the claim as denied and move to the next stage — and a plan that fails to follow reasonable procedures may lose deferential review.

Stage 6: Watch for new rationales

Under the ACA regulations, if the plan develops new or additional evidence or a new rationale during the appeal, it must give it to you free of charge and sufficiently in advance of the decision so you can respond.

If the final denial rests on a ground you never saw, say so in writing. That is a procedural violation, and it is a strong argument in external review and in litigation.

Stage 7: External review — do not skip this

After the final internal denial, request external review by an Independent Review Organization. It is free, the reviewer is a physician with no relationship to the plan, and the decision binds the plan.

Where to file. For fully insured and individual coverage, the state process — usually through the Department of Insurance, and the denial letter states how. For self-funded ERISA plans not subject to a state process, the federal external review process.

Deadline: generally four months from the final internal denial.

What it covers: denials involving medical judgment — medical necessity, appropriateness, level of care, effectiveness, experimental or investigational status — and rescissions. It generally does not cover pure eligibility or contractual exclusions, which is why characterizing the denial matters.

What to submit: everything from the internal appeal, plus anything new. Unlike the internal appeal, this is a fresh clinical look, and additional evidence is welcome.

Expedited external review is available concurrently with an expedited internal appeal for urgent situations.

This is the step most likely to succeed, and it is the step claimants most often never take, because the internal denial reads like the end.

Stage 8: Regulatory complaints — file them in parallel

These cost nothing and they produce movement.

State Department of Insurance (fully insured and individual coverage). Free, online, and insurers respond because complaint volumes are tracked, reported, and used in market conduct examinations. This is the most underused consumer tool in health coverage.

U.S. Department of Labor, Employee Benefits Security Administration (ERISA plans). Benefits advisors will contact the plan and frequently resolve procedural failures without litigation.

Centers for Medicare & Medicaid Services for No Surprises Act violations, and the federal complaint process for balance billing in protected situations.

State attorney general consumer protection division, where the conduct is a pattern.

The state insurance commissioner's market conduct division, for systemic issues such as parity violations.

Stage 9: If it goes to court

For an ERISA plan, the action is under 29 U.S.C. § 1132(a)(1)(B) to recover benefits.

Three things to understand before you get here:

The record is generally closed. In most circuits the court reviews only what was before the administrator. Everything you wanted a judge to see had to be submitted during the internal appeal. This is why Stage 5 says "anything you might ever want a judge to see."

The standard is usually deferential. Under Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), review is de novo unless the plan grants discretionary authority — which nearly all do. Several states ban discretionary clauses in insurance policies, so check whether yours does.

The remedies are narrow. Benefits, interest, and attorney's fees under § 1132(g), available on "some degree of success on the merits" per Hardt v. Reliance Standard Life Insurance Co., 560 U.S. 242 (2010). No compensatory or punitive damages, no jury, and state bad faith claims are preempted.

The arguments that work on a deferential standard: the administrator relied on a paper reviewer who never examined the claimant while disregarding treating physicians without explanation (Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003) permits no arbitrary refusal to credit reliable evidence); the same entity decided and paid, and the circumstances suggest bias (Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105 (2008)); the plan applied criteria not in the plan document; the plan failed to follow its own claims procedure; and the denial rests on a rationale first disclosed in the final letter.

Fee shifting makes representation available. Do not assume you cannot afford an ERISA lawyer.

Stage 10: Special situations

Prescription drugs. Formulary exclusion → request a formulary exception. Step therapy → request a step therapy exception based on prior failure, contraindication, or expected ineffectiveness; most states mandate an exceptions process with a short turnaround. Quantity limits → a separate exception request.

Emergency care denied on the final diagnosis. Quote the prudent layperson standard and attach the triage note. Reasoning backward from the discharge diagnosis is unlawful.

Balance bill after out-of-network care at an in-network facility, or emergency care. Check the No Surprises Act protections — you owe only in-network cost sharing, and there is a federal complaint process.

Mental health or substance use denial. Request the plan's parity comparative analysis of non-quantitative treatment limitations. Plans must maintain and produce it, and the request reframes the dispute.

Out-of-network because no in-network provider exists with the necessary expertise → request a network adequacy exception at in-network cost sharing.

Stage 11: The bill, while you appeal

Tell the provider in writing that an appeal is pending. Most will hold the account rather than send it to collections.

Ask about financial assistance. Nonprofit hospitals must maintain and publicize a financial assistance policy, and eligibility thresholds are frequently far higher than patients assume. This is separate from the insurance dispute.

Request an itemized bill and check it for duplicates, services not rendered, wrong codes, and charges included in a facility fee.

Protect your credit. Medical debt reporting is now substantially restricted, and a disputed medical bill on a credit report can be disputed under the FCRA.

Keep receiving care. A denial is a payment decision, not a medical one. A gap in treatment harms the patient and weakens the appeal.

Stage 12: Two appeals, start to finish

The infusion denied as "experimental"

Day 1. Priya's rheumatologist prescribes a biologic infusion. The plan denies: "experimental/investigational for the requested indication."

Day 2. She asks HR in writing whether the plan is self-funded. It is — which tells her three things: no state coverage mandate helps her, there is no bad faith claim, and if this ends in court the record will be closed and the standard deferential. She treats the internal appeal as her only chance.

Day 3. She requests the claim file, specifically the plan's definition of "experimental," the criteria applied, and the reviewer's credentials. The file arrives in three weeks: the reviewer is board-certified in emergency medicine, and the plan's own definition excludes treatments "not recognized as safe and effective by the medical community for the condition."

Week 5. Her rheumatologist writes a letter addressing that definition word by word: the drug is FDA-approved for a related indication; the use is listed in a recognized compendium; four peer-reviewed studies are attached with the relevant conclusions quoted; and the letter notes that a reviewer without rheumatology training is not positioned to assess community recognition in the specialty.

Week 6. Internal appeal filed, with everything, and a cover line requesting that all of it be included in the administrative record.

Week 12. Denied.

Week 13. She requests federal external review — available because the self-funded plan is not subject to a state process.

Week 19. The independent reviewer, a rheumatologist, overturns the denial. The plan is bound. Total cost to her: postage.

The residential treatment denied at day eleven

Day 11. Marcus's daughter is in residential treatment for an eating disorder. The plan authorizes eleven days and denies continued stay for want of "imminent risk."

Day 11. He requests an expedited internal appeal — delay would jeopardize her health — and files it the same day, so the plan must decide in 72 hours. He simultaneously requests the claim file and the plan's criteria.

Day 12. The treating psychiatrist writes a letter tracking each criterion by name — weight trajectory, vital signs, behavioral findings, and the specific reason a lower level of care had failed twice.

Day 14. Expedited appeal denied.

Day 14. He files expedited external review and, the same day, a Department of Insurance complaint and a written request for the plan's mental health parity comparative analysis — asking how continued-stay review for behavioral health compares with concurrent review for medical-surgical admissions.

Day 17. External review overturns the denial and authorizes continued stay. Two months later the plan revises its behavioral health concurrent review process following the regulator's parity inquiry.

What decided both: requesting the file, answering the plan's own criteria in the plan's own words, and not stopping at the internal denial.

Stage 13: The appeal calendar

Stage 14: Fifteen mistakes

1. Not appealing at all. A large share of denials are overturned; a larger share are never challenged.
2. Appealing by telephone. A call is not an appeal and leaves no record.
3. Not asking whether the plan is self-funded, and therefore not knowing which rules apply.
4. Never requesting the claim file, and appealing blind to the criteria the denial rests on.
5. Not checking the reviewer's specialty.
6. A general letter of support instead of a letter answering each stated ground in the plan's own words.
7. Not documenting the treatment history — what was tried, how long, why it failed — which is what defeats step therapy and "less intensive alternative" denials.
8. Missing the 180-day internal deadline.
9. Not requesting expedited review when delay would jeopardize health.
10. Holding back evidence for a later stage. On an ERISA plan there is no later stage; the record closes.
11. Stopping after the internal denial and never requesting external review — the free, binding, most successful step.
12. Not filing a regulatory complaint in parallel, which costs nothing and produces movement.
13. Paying a balance bill that the No Surprises Act prohibits.
14. Never asking about hospital financial assistance, which can resolve the bill regardless of the appeal.
15. Stopping treatment during the dispute, which harms the patient and undermines the necessity argument.

Stage 15: Preventing the denial

Most of what goes wrong is preventable, and the prevention costs nothing.

Before a planned service:

• Verify coverage in writing. Not a phone call — ask for written confirmation of benefits, and if only a call is available, record the date, time, representative's name, and reference number, and follow up with an email summarizing what you were told.
• Confirm prior authorization is obtained, and get the authorization number. Do not assume the provider handled it; confirm it yourself.
• Verify the network status of everyone involved — the facility, the surgeon, the anesthesiologist, the pathologist, the radiologist, and the assistant. The facility being in network does not mean the anesthesiologist is, and this is the single most common source of surprise bills.
• Ask the provider for the CPT and diagnosis codes and give them to the plan when verifying, because coverage is determined by code.
• Check whether the authorization has an expiration date and a unit limit.

Choosing a plan, once a year:

• Read the formulary for the drugs you actually take, and check the tier and any step therapy or prior authorization requirement.
• Check the network for the providers you actually see, by name, on the plan's current directory — and then call the provider's office to confirm, because directories are frequently wrong.
• Compare the total exposure, not the premium: premium plus deductible plus out-of-pocket maximum, against your realistic use.
• If you have a chronic condition or a planned procedure, model the year. The cheapest premium is frequently the most expensive plan.

Throughout the year:

• Keep an explanation-of-benefits file and reconcile each against the bill you receive. Never pay a provider bill that exceeds the patient responsibility shown on the EOB.
• Do not pay at the point of service beyond a stated copay, particularly for a facility that asks for an estimated balance before the claim has been processed.
• Track the deductible and out-of-pocket maximum, because plans do make accumulator errors and they are correctable.
• When something is denied, appeal it immediately rather than at the deadline. Momentum matters, and the record is fresher.

And one structural point. The denial process is not designed around what a sick person can manage. Anyone who can — a spouse, an adult child, a friend — should take over the paperwork, the calls, and the calendar. The person receiving the treatment is the worst-positioned person in the household to run the appeal.

Stage 16: Where to get help

• Your state Department of Insurance consumer assistance line (fully insured and individual coverage). Free, staffed, and empowered to contact the insurer on your behalf. Call this before hiring anyone.
• The U.S. Department of Labor, Employee Benefits Security Administration, for ERISA plans. Benefits advisors will contact the plan and frequently resolve procedural failures without litigation.
• A state Consumer Assistance Program, where your state operates one. They help file appeals, at no cost.
• The hospital or clinic's patient advocate or financial counselor. They know the plan's requirements, they file appeals routinely, and they have an interest in the claim being paid.
• Your employer's benefits department. For a self-funded plan, the employer pays the claims, and a benefits manager who calls the administrator carries weight that a member does not.
• Nonprofit patient advocacy organizations for your specific condition, several of which run free appeal assistance programs and maintain template letters and literature citations.
• A professional patient advocate, who charges hourly or a percentage and is worth considering for a large claim or a complex ongoing course of treatment.
• An ERISA benefits attorney, for a denial that survives external review or for a disability or life claim. Fee shifting under § 1132(g) makes representation available, and most take strong cases on contingency — do not assume you cannot afford one.
• Legal aid and law school clinics, several of which run health law practices.
• The Veterans Crisis Line, 988, or 911 — none of this administrative process should delay urgent care. Get the treatment and litigate the payment.

Two closing points.

The system is not designed to be navigated by the person who is ill. It is designed around forms, deadlines, and documentation, at a moment when the claimant is least able to manage any of them. That is not a reason to give up; it is a reason to hand the file to someone else in the household and to use the free help above, which exists precisely for this.

And the arithmetic favors appealing. The internal appeal costs postage and a physician's letter. External review costs nothing and binds the plan. A substantial share of appealed denials are overturned, and the ones that are never appealed are all upheld by default. The single most consequential decision in this entire guide is the decision to file the first appeal.

Stage 17: Denials of long-term disability and life benefits

The same law governs employer-provided disability and life insurance, and the appeal follows the same sequence — but the evidence is different, and the deadlines are shorter than people expect.

Long-term disability terminations cluster at two moments. The first is the 24-month change of definition, when "unable to perform your own occupation" becomes "unable to perform any occupation for which you are reasonably suited." An appeal that resubmits the same medical evidence loses; what is needed is vocational evidence addressing the new standard. The second is after surveillance or a paper file review by a physician who never examined the claimant.

What to build into the record, before it closes:

• A functional capacity evaluation, which converts diagnosis into measured limitation.
• Treating physician statements addressing specific work functions — sitting, standing, lifting, concentration, attendance, pace — rather than diagnosis.
• A vocational expert opinion applying the policy's actual definition.
• An activity log kept over several weeks.
• Statements from a spouse, coworkers, or a former employer describing daily function and the accommodations that were required.
• The SSDI award, if you have one. Most policies require you to apply for it and then offset the benefit against it, while arguing in the disability appeal that you can work. Point out the inconsistency; the award is powerful evidence.

Address the surveillance directly. A claimant photographed carrying groceries is not thereby able to sustain an eight-hour workday. Left unanswered, the footage becomes the record's most vivid item.

Watch the mental health and "self-reported symptoms" limitation, which caps benefits at 24 months in most policies. Where an objectively documented physical condition contributes independently, plead and prove it separately.

Life and accidental death denials turn on different questions: the contestability period and alleged misrepresentation on the application; whether the death was "accidental" as the policy defines it; intoxication and self-inflicted injury exclusions; and — most commonly — a beneficiary designation never updated after a divorce or remarriage, where for an ERISA plan the designation on file generally controls regardless of a state revocation-on-divorce statute.

And the deadline nobody knows: group life coverage usually carries a conversion right — often only 31 days after employment ends — to convert to an individual policy without evidence of insurability. It is in the certificate, and it is missed constantly by people who are, at that moment, thinking about other things.

Stage 18: Coverage disputes, which are not clinical

Not every denial is about medicine, and the non-clinical ones follow different rules and different clocks.

Rescission. A plan may not retroactively cancel coverage except for fraud or an intentional misrepresentation of material fact, and only with at least 30 days' advance notice. A rescission is an adverse benefit determination — appealable internally and through external review, which insurers do not volunteer.

COBRA. After a qualifying event you generally have 60 days to elect and 45 days thereafter to pay, and coverage is retroactive to the loss of coverage. Two things go wrong: the election notice is never sent (the employer's obligation, with statutory penalties for failure), and people decline because they think the gap is uncovered — when in fact care received during the election window is covered once premiums are paid.

Special enrollment periods. Loss of coverage, marriage, birth or adoption, or a permanent move opens a 60-day window to enroll outside open enrollment. Compare marketplace coverage with a subsidy against COBRA before electing; for many households the marketplace plan is dramatically cheaper, and electing COBRA first can complicate the choice.

Termination for nonpayment. Grace periods differ sharply. A marketplace enrollee receiving advance premium tax credits gets a three-month grace period, with claims in months two and three held pending payment. Others may get thirty days or less. Find out which applies before assuming coverage lapsed.

Eligibility disputes — hours thresholds, dependent status, a stepchild or domestic partner — are plan-interpretation questions and follow the same claims and appeal procedure. Request the plan document and the enrollment records.

Coordination of benefits. "The other plan is primary" is a coordination dispute, not a coverage denial. The birthday rule for dependent children and the active-employee-over-retiree rule resolve most of them.

The point that ties these together: each is an adverse benefit determination carrying the full appeal machinery — written notice with specific reasons, the right to the claim file, internal appeal, and usually external review. People treat coverage problems as customer service matters to be resolved by telephone. They are legal determinations with deadlines, and they should be handled in writing from the first day.

Stage 19: What a good appeal letter looks like

Most appeal letters are two paragraphs of frustration. Here is the structure that works, and it is short.

Re: Appeal of adverse benefit determination · Member [name], ID [] · Claim [] · Date of service [] · Denial dated []

I am appealing the denial of [service]. The denial should be reversed because [one sentence].

---

1. What was denied and why. On [date] the plan denied [service] on the ground that it is "[quote the stated reason exactly]." The letter cites [plan provision].

2. The plan's own criteria are met. The criteria produced in response to my document request state that [service] is covered where: (a) [criterion]; (b) [criterion]; (c) [criterion].

Criterion	Met?	Where in the record
(a) [__]	Yes	Dr. [__] note, [date], p. 2
(b) [__]	Yes	Imaging report, [date]
(c) [__]	Yes	Treatment log, [dates]

3. Treatment history. [What was tried, for how long, at what dose, and why it failed or was contraindicated. This defeats a "less intensive alternative" or step therapy rationale.]

4. The reviewer's qualifications. The determination was made by [name], board-certified in [specialty]. The condition at issue is [specialty]. I request that the appeal be reviewed by a physician in the appropriate specialty.

5. The plan language covers this. Section [] of the certificate provides "[quote]." The exclusion relied upon, Section [], applies to [__], which is not this service.

6. Enclosures, all of which I request be included in the administrative record: · Letter of medical necessity from Dr. [], dated [] · Medical records, [dates], with supporting entries flagged · [Literature] · [Prior authorization/reference numbers]

7. Requests. That the denial be reversed and the claim paid; that this appeal be reviewed by a physician in the relevant specialty; and that I be provided, free of charge and sufficiently in advance of the decision, any new or additional evidence or rationale developed during this review, with an opportunity to respond.

[Name · date · sent by [traceable method]]

Why each piece is there. The table converts a clinical argument into a checkable comparison. The specialty request preserves an objection. Item 7 preserves the procedural rights that matter most on external review and in litigation. And the enclosure language ensures the record contains what you want a judge to see — which, on an ERISA plan, is the difference between an argument you can make and one you cannot.

Stage 20: Keeping the file

Every step in this guide produces paper, and the file is what makes the later steps possible.

Keep one folder, organized in five parts. Coverage documents: the Summary Plan Description, the certificate of coverage, the formulary, and the written confirmation of whether the plan is self-funded. The claim: the provider's records, the codes, the prior authorization number, and the explanation of benefits. The denial chain: every letter, in date order. What you produced: the claim file the plan sent, the criteria, the reviewer credentials, the medical necessity letter, and every enclosure. Communications: a call log with date, time, name, and reference number for every conversation, and copies of every email.

Keep proof of delivery for everything you send. Certified mail, a fax confirmation, or a portal submission receipt. In a dispute about whether an appeal was timely, this is the whole question.

Record every call the same day. Insurers' own notes are discoverable and frequently contradict what claimants were told — but only if you can say when the call happened and with whom.

Do not throw anything away when the appeal succeeds. Denials recur, particularly for ongoing treatment, and the file that won last year's appeal is the fastest route through this year's.

And note the two dates that govern everything, on the front of the folder: the internal appeal deadline, and the external review deadline. Almost every irrecoverable loss in this area is a missed date rather than a lost argument.

Frequently asked questions

How long do I have? Usually 180 days for the internal appeal, and about four months from the final internal denial for external review. The letter states both.

Does appealing cost anything? Internal and external appeals are free.

Can my doctor appeal for me? Yes, as your authorized representative — and you should also file, so that everything you want in the record is in it.

What if the plan misses its deadline? You may generally treat the claim as denied and proceed, and the plan may lose deferential review.

Is external review really binding? Yes. That is what makes it the most valuable step.

What if I already paid the bill? Appeal anyway. A successful appeal produces reimbursement.

How do I find out if my plan is self-funded? Ask HR in writing, or read the Summary Plan Description. It changes nearly every answer.

Related documents

• Health Insurance Denials and Appeals
• Health Coverage Denial and Appeal Checklist
• Health Insurance Appeal Toolkit
• Medicare: Enrollment, Coverage, and Appeals
• Elder Law and Long-Term Care
• Consumer Financial Protection Statutes
• Debt Collection and the FDCPA
• Attorneys Fees and Costs

This guide is educational and not legal advice. Whether ERISA or state law governs changes nearly every answer. Consult counsel or your state Department of Insurance about a specific denial.