Appeal a Denied Health Insurance Claim with ChatGPT

What does this setup do?

You upload the denial letter and your plan's coverage pages, ChatGPT or Claude explains the denial reason and pulls out your deadline, and it drafts an internal appeal letter and a checklist of what to attach. You send the appeal.

Who is it for?

For anyone whose health plan refused to pay for a visit, test, or treatment and who isn't sure what to write back.

How do you set it up?

Tools

• ChatGPT Free or Claude Free. Upload limits apply on ChatGPT Free.
• The denial letter or Explanation of Benefits that shows the denial
• The pages of your plan document that cover the service
• A letter or notes from your doctor supporting the care, if you can get one

Steps

1. Find the date on the denial notice. HealthCare.gov says you have 180 days from that notice to file an internal appeal. Put the deadline on your calendar.
2. Black out your member ID and Social Security number. Upload the denial letter and the plan pages it mentions with the prompt below.
3. Read the plain-English summary of why the claim was denied, and check it against the letter yourself.
4. Ask your doctor for a short letter that answers the denial reason, and add it to the chat.
5. Have the chat draft the appeal letter and a checklist of what to attach. Use your insurer's form if it has one.
6. Send the appeal yourself and keep copies. Log every phone call with the date, time, and name of the person you spoke to.
7. If the plan says no again, its final letter has to explain how to ask for an external review. You have 4 months from that notice to file.

Help me appeal a denied health insurance claim. Don't send anything or contact anyone for me.

Attached: the denial letter, the plan pages it cites, and my doctor's note if I have one. I've blacked out my ID numbers.

1. In plain English, tell me the exact reason for the denial and quote the line from the letter.
2. Pull out any deadline, claim number, and appeal address or form the letter mentions.
3. Draft an internal appeal letter under one page: my name, claim number, the service and date, why it should be covered, and which attached documents back that up. Use only facts from my documents.
4. List what to attach and what I still need to get.

Rules: Don't invent medical facts, policy language, or laws. If the denial reason is unclear, tell me what to ask the insurer.

Which chat tools work with this prompt?

Paste the prompt into any of these assistants (free or paid tiers).

• ChatGPT
• Claude

What tips make it smoother?

• Answer the exact reason in the letter. A medical-necessity denial needs your doctor's reasoning. An out-of-network denial needs the facts about where you got care.
• Your state's Consumer Assistance Program can file the appeal for you, per HealthCare.gov.
• If your care is urgent, you can ask for an external review at the same time as the internal appeal.

Where do the claims come from?

Summaries use public sources linked below, not independent verification. How setups are picked.

• Read HealthCare.gov’s write-up (www.healthcare.gov)

  HealthCare.gov: Internal appeals: file within 180 days of the denial notice, what to include, and decision timelines of 30 or 60 days.

• Read HealthCare.gov’s write-up (www.healthcare.gov)

  HealthCare.gov: External review: request within 4 months of the final denial, standard decisions within 45 days, and a cost of $0 to $25.

• Read OpenAI Help Center’s write-up (help.openai.com)

  OpenAI Help Center: Free plan users can search the web and upload images or files; uploads have their own usage limit.

• Read Claude Help Center’s write-up (support.claude.com)

  Claude Help Center: How to attach PDFs and images in a chat, with per-file and per-chat limits.