Will Basis Appeals write an appeal for my situation

Short answer: if you got a written denial from a US health insurer and you are still inside the appeal window, yes. There are a few situations where another route is faster or better, and this article walks through both.

What we cover

Basis Appeals drafts a first-level internal appeal letter, and on higher tiers a second-level template and an external-review request, for these plan types:

• Commercial group health plans (the plan your employer sponsors)
• Individual and family plans bought on or off a state exchange
• Self-funded ERISA plans (large employers)
• Medicare Advantage (Part C)
• Medicaid managed care

We generate the letter from the denial code, the insurer, the plan year, and the short narrative you type in. The letter cites the rule that applies to your plan type: ERISA 29 CFR 2560.503-1 for group health, ACA section 2719 (45 CFR 147.136) for external review on non-grandfathered plans, 42 CFR 422.582 for Medicare Advantage reconsideration, and 42 CFR 438 for Medicaid managed care.

What we do not cover

• Original Medicare (Part A or B) redeterminations. These use a different process and forms. Call 1-800-MEDICARE or start with your Medicare Summary Notice.
• VA claims. These go through the VA, not a commercial insurer.
• TRICARE. Similar, use the TRICARE appeal process.
• Workers compensation denials. State workers-comp boards, not health-insurance appeals.
• Dental-only or vision-only plans. These have their own rules and are not in scope.
• Prior-authorization requests before care. Basis Appeals is for denials after a claim. If you have not received care yet, you are asking for prior authorization, which is a different form.

Situations where you should call a lawyer instead

• The denial involves a claim over roughly $50,000 and is medically complex
• You are in active cancer treatment and time is a critical factor
• The insurer is refusing to acknowledge a valid claim at all (not just denying it)
• Your employer plan document was recently changed in a way you cannot explain

An ERISA attorney is the right partner for those. We keep an article on how to find one at When to hire an ERISA attorney (and how).

What to check before you buy

1. Do you have the denial letter, EOB, or portal screenshot with a denial code on it? (If not, request one in writing from the insurer.)
2. Are you inside the appeal window? Group health plans give you 180 days from the date of denial. Medicare Advantage gives you 60 days. Medicaid managed care varies by state.
3. Do you know your insurer and plan year?

If all three are yes, the intake form takes about five minutes and you preview the draft before paying.

Not sure

Preview a draft for free at /new. You only pay if the preview looks useful for your situation. Nothing charges without your click.