Paste the denial
Upload the EOB or paste the denial reason code (e.g., CO-50, PR-204) and any explanation the insurer gave.
Insurance appeal
Your insurance denied the claim. Here's how to fight it.
Some denials can be corrected or appealed when the denial reason and evidence line up. We help you draft a formal internal appeal in plain English for $19, or upgrade to a Full Audit if the bill itself looks wrong too.
Why claims get denied
Six common reasons. All worth checking.
Most insurance denials fall into six buckets. A denial is not always final, but the right next step depends on the notice, plan type, and evidence.
- Coverage / benefits — insurer says the service isn't covered under your plan. Check your benefits summary; many denials are simple coding errors.
- Medical necessity — insurer says the service wasn't medically necessary. Provider documentation may help if it answers the denial reason.
- Pre-authorization — service required prior approval that wasn't obtained. Check who was responsible and what the plan notice says.
- Out-of-network — service billed as out-of-network. Check if the No Surprises Act applies.
- Coding error — wrong CPT, modifier, or diagnosis code. Frequently corrected at the provider level before a formal appeal.
- Duplicate — claim looks like a duplicate. Reset by submitting documentation of the original date of service.
Many plans list appeal deadlines and submission instructions on the EOB or denial notice. Confirm that deadline first, then file through the route your plan specifies.
How the $19 generator works
Three minutes. One tailored letter.
Tell us your plan type
ACA marketplace, employer fully-insured, employer self-funded, Medicare, Medicaid, or government program. The generator keeps the appeal language cautious when the route is uncertain.
Get the letter
A formal internal appeal draft, provider-document request, insurer call script, and external-review prep notes emailed to you and shown on screen.
FAQ
Common questions.
How is the BillBusted Appeal Generator different from the $29 Resolution Pack?
The BillBusted Appeal Generator differs from the $29 Resolution Pack in scope. The Appeal Generator ($19) targets a single insurance claim denial and drafts an internal appeal letter aimed at your insurer. The Resolution Pack handles the broader medical bill — comparing it to the EOB, flagging billing errors, and drafting letters to the provider. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024).
Will an insurance appeal definitely work?
An insurance appeal will not definitely work — outcomes depend on your plan's coverage, the medical documentation, the denial reason, and the insurer's review. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024), so the odds favor a well-organized appeal, but every case is unique. The Appeal Generator drafts cautious, evidence-anchored language so the appeal lands on the right rule for your plan type.
How long does the insurer have to respond to my appeal?
How long the insurer has to respond to an appeal depends on plan type and urgency: ACA marketplace and most ERISA plans are 30 days for pre-service appeals and 60 days for post-service. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024). Confirm the exact deadline on the denial notice or in your Summary Plan Description, and ask the insurer to confirm receipt in writing once you file.
What if my internal insurance appeal fails?
If your internal insurance appeal fails, you may have an external review or another complaint route — ACA marketplace plans guarantee external review through an Independent Review Organization, and ERISA self-funded plans often offer one too. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024). The Appeal Generator includes prep notes for external review, and DOL EBSA is the federal escalation path for self-funded plans.
Have a bill in front of you right now?
The free scan answers one question in 60 seconds: does this bill deserve a closer look?