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insurance-claim-appeal

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Appeal a denied insurance claim — read the real reason for the denial, find the strongest grounds, and draft the appeal with the evidence that answers it. Use when asked to appeal a denied claim, my insurance claim was rejected, the insurer won't pay, or how do I fight a claim denial. Produces a decode of the denial reason, the best grounds to appeal on, a structured appeal letter citing your policy, the evidence checklist, deadlines to watch, and the external-review/ombudsman escalation. Not legal or regulated advice.

skills/insurance-claim-appeal/SKILL.md

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Nov 10, 2026
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# Insurance Claim Appeal

A denial is often a first offer, not a verdict. Insurers deny for specific, stated reasons — "not medically necessary," "pre-existing," "outside coverage," "insufficient documentation" — and a large share get overturned on appeal when the claimant answers that exact reason with the right evidence and cites their own policy back. This decodes the denial, picks the strongest grounds, and writes the appeal — while being clear it's a preparation aid, not regulated advice.

## What This Skill Produces

- **The denial decode** — what the stated reason actually means, and what specifically must be rebutted
- **The grounds** — the strongest basis to appeal (coverage misread, documentation gap, coding/error, medical-necessity, procedural mistake by the insurer)
- **The appeal letter** — structured, citing your policy section, the claim/reference numbers, and the evidence that answers the denial
- **The evidence checklist** — records, letters, receipts, or a provider's statement that directly rebut the reason
- **Deadlines & escalation** — the appeal window (often tight), internal vs external review, and the ombudsman/regulator path if the internal appeal fails

## Required Inputs
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