HOW TO: Find out why your health insurer denied your claim.

ProPublica’s Claim File Helper lets you customize a letter requesting the notes and documents your insurer used when deciding to deny you coverage. Get your claim file before submitting an appeal.

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This free tool is part of our “Uncovered” series on health insurance denials. Please note that ProPublica is unable to provide any legal advice about claim files. We are journalists and not lawyers.

What’s a Claim File? Why Should I Request One?

A claim file is a collection of the information your insurer used to decide whether it would pay for your medical treatment or services. Most people in the U.S. facing a denial have the right to request their claim file from their insurer. It can include internal correspondence, recordings of phone calls, case notes, medical records and other relevant information.

Information in your claim file can be critical when appealing denials. Some patients told us they received case notes showing that their insurer’s decision was the outcome of cost-cutting programs. Others have gotten denials overturned by obtaining recordings of phone calls where company staff introduced errors into their cases.

How This Works

Answer a few questions to generate a PDF of your claim file request letter.

Mail, fax or upload the completed letter to your health insurer.

Your claim file request should be fulfilled within 30 days.

If you agree to be contacted, we’ll email you later to see if you’ve received your file.

By law, health insurers’ responses should be timely and the records provided by the company should explain why they denied your claim or prior authorization request. However, ProPublica has found that some insurers don’t respond to claim file requests, or they do respond but send inaccurate or incomplete information. If this happens to you, see “I submitted my request but am having trouble getting my claim file. What can I do now?” under “Other Questions” below.

What Is ProPublica?

ProPublica is an independent, nonprofit newsroom that produces investigative journalism in the public interest. As part of the “Uncovered” series, our reporters are investigating how and why the American health insurance industry denies coverage to patients.

Why Did ProPublica Make This?

ProPublica wants to make it easier for people to access their claim files and to craft better appeals. Insurers deny tens of millions of claims every year. Knowing why your claim or prior authorization request was denied can be key to submitting an effective appeal, but most people don’t know that they have a right to this information. Few insurers offer instructions or templates on their websites, and even fewer advertise any guidance they do offer.

Also, claim files that people have chosen to share with our newsroom have helped us shed light on how health insurers handle claims, which is often an opaque process. When people choose to share their claim files with ProPublica, we can get a better understanding of how health insurance denials work and do more reporting.

Is ProPublica Collecting My Information?

No, ProPublica does not store any information you enter into the Claim File Helper without your consent. When filling out the form, you can choose to share your contact information and insurance plan name with us. This is completely optional. If you consent, your information will only be used to help us further report on health insurance denials, and ProPublica will not publish or share your information without obtaining your consent. Your insurer will not send any documents directly to ProPublica.

Other Questions

An appeal asks the health insurance company to reconsider its denial. A claim file request prompts the insurer to send you the information it considered or generated before it issued the denial. Patients, advocates and lawyers recommend requesting your claim file before you make an appeal. That way, you can incorporate what you learn in any future steps you take.

You should get a response to your claim file request within 30 days of the insurer receiving it.In practice, ProPublica has found that some insurers can be unresponsive. Many people we interviewed received their claim files anywhere from one to three months after submitting their requests, while some haven’t gotten them back at all. If your insurer does not adequately respond, you can alert the agency that regulates your type of health insurance plan. In some cases, people have sued their health plan provider for failing to produce a claim file on time. For more detail, see “I submitted my request but am having trouble getting my claim file. What can I do now?

Many people use this information to appeal a denied claim or request for treatment, particularly if they notice errors in the decision-making process for their case.You can also share your claim file with ProPublica reporters as we continue to report on health insurance denials. These documents can help provide a unique window into the denial process. Share your claim file with ProPublica here.

You are not alone. ProPublica has found that insurers sometimes mistakenly process claim file requests as if they’re appeals, wrongly require a subpoena from patients who are requesting their claim files, or provide an incomplete file in response to a request. If you’re having trouble, you can contact the agency regulating your health insurer using the information below.

If You Got a Denial From … The Insurer Is Regulated by … You Can Contact the Agency at …
An insurance plan sponsored by a private employer.*

The employer is not a city, state or federal government agency. I am the employee or a covered dependent.
Department of Labor Ask EBSA page
Request assistance online
An insurance plan sponsored by a state or local government employer.*

I am the employee, a covered dependent or a retired employee. Or I received a denial from Medicare.
Centers for Medicare & Medicaid Services 877-267-2323
An insurance plan sponsored by a federal government employer.*

I am the employee, a covered dependent or a retired employee.
U.S. Office of Personnel Management Contact page for OPM: Healthcare & Insurance
An individual or student plan purchased in my state or through

The plan is not employer-sponsored, a short-term plan or travel insurance.
Your state insurance agency, or the U.S. Department of Health and Human Services, which has joint enforcement agreements with states. Find your state insurance agency through the National Association of Insurance Commissioners.
*Applies only to self-funded plans, where employers pay directly for workers’ health care and contract with insurers to administer claims. Many employer-sponsored plans are self-funded, and your employer’s human resources department can help you figure out if that is the case. If your plan is fully insured, meaning that your insurer, not your employer, pays out the claims itself, you should reach out to your state insurance agency.
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