You bought a letter, here's what happens next

Take a breath. The hard part is done. The next 30 to 45 days follow a predictable pattern. Here is the map.

This week

1. Open the PDF and read it end to end. Confirm the recipient block matches your insurer's appeals address. Confirm the RE: line names the correct member, claim number, and date of service. Confirm the citation slot names the rule that fits your plan type (ERISA 29 CFR 2560.503-1 for group health, ACA section 2719 for external review, 42 CFR 422 for Medicare Advantage, 42 CFR 438 for Medicaid managed care). If any of those look wrong, see My letter has a typo or The insurer address on my letter is wrong.

2. Sign it. The letter has a signature block. Sign in blue or black ink. Do not print your signature; sign by hand.

3. Gather your enclosures. The letter lists what to include. Usually the EOB or denial letter, and (if medical necessity) your provider's supporting notes. See Should I attach my EOB, medical records, or both.

4. Print two copies. One to mail, one for your file. If you have access to a scanner, scan the mailed copy after you sign it, so your file version matches the exact document the insurer receives.

5. Mail it USPS Certified Mail with Return Receipt. Step-by-step at How to send by certified mail. Save the tracking number in a note on your phone.

Weeks 2 through 4

• The tracking site should show delivery within a few days
• Once delivered, the plan's clock starts. For ERISA group health post-service claims, the plan owes you a written decision within 60 days (29 CFR 2560.503-1(i))
• The plan may request more information. If so, respond in writing (see What if my insurer requests more information)
• Do not call to "check on it." Every call risks losing the paper trail. The next move is the plan's

Weeks 4 through 6

• The plan should send a written decision. Save it
• If reversed, you are done. Celebrate. Consider replying with a request to reprocess the claim so payment issues
• If upheld, you have options. See How to file a second-level appeal if the first is denied or How to request an external review
• If no response, see What if you don't hear back in 30 days

If you bought $99 or $199

Your PDF includes a second-level template and, on $199, an external-review packet. You do not need to send those until (or unless) the first-level appeal is upheld. Save them.

Keep every artifact

Keep the following in one folder, physical or digital:

• The original denial letter and EOB
• Your signed appeal letter (the copy you mailed)
• The certified-mail receipt with tracking number
• The Return Receipt "green card" when it comes back
• The plan's written decision
• Any correspondence in between

This is your paper trail. It matters if you escalate. See How to keep a paper trail that helps a future lawyer.

When to email support

• The PDF looks wrong
• The insurer says they never received it
• The plan asks for information that seems designed to trip you up

We answer within two business days. Include your appeal ID.