This letter is not an appeal. The time to appeal counts from your plan’s notice, not from this letter, so keep the date on your notice in view while you wait. Your notice sets your actual date. (29 CFR 2560.503-1(h)(3)(i), job-based health plans; 42 CFR 405.942(a), Original Medicare)
Sample letter requesting a claim file from a health plan
It fills in as you type. Anything you leave empty stays in brackets, so you can see what is still missing.
30 days from today to start with. Change it if you like. The date to appeal by is the one on your notice.
It reminds you at 9 in the morning on that day. The calendar file says “A date for your medical bill” and links to MedBillCheckup. It names no provider, amount or person, and nothing you type here is sent to us.
Which rule covers your plan
- If your plan is a job-based plan covered by ERISA, its claims procedure must give you, on request and free of charge, reasonable access to and copies of all documents, records and other information relevant to your claim. (29 CFR 2560.503-1(h)(2)(iii), and (h)(3) for health plans)
- “Relevant” covers what the plan relied on; what was submitted, considered or generated in making the decision, even if the plan did not rely on it; what shows the plan followed its own safeguards for consistent decisions; and, for a health plan, any statement of policy or guidance about the denied treatment for your condition. (29 CFR 2560.503-1(m)(8))
- A health plan’s notice must name any internal rule or guideline it relied on, or say you can have a copy free on request. For a decision based on medical necessity or experimental treatment, it must explain the clinical judgment, or say you can have that explanation free on request. (29 CFR 2560.503-1(g)(1)(v))
- ERISA does not cover government plans, or church plans that have not chosen to be covered. (29 U.S.C. 1003(b), plans ERISA does not cover)
- A plan you bought yourself, on the Marketplace or from an insurer, follows the same claims rule as a job-based health plan. Job-based plans and plans you bought yourself must also let you review the claim file as part of their claims and appeals process, and give you on request the diagnosis code and the treatment code for a decision, with their meanings. Asking for those codes is not, by itself, an appeal. A plan that is “grandfathered” is generally outside these rules. (45 CFR 147.136(a)(1)(ii), (b)(2)(ii)(C) and (E), (b)(3)(i), (b)(3)(ii)(C) and (E))
- Medicare Part A and Part B, and Medicare Advantage, are health plans under the federal health privacy rule (HIPAA). You may ask a health plan for its enrollment, payment and claims records about you. It acts within 30 days, or once 30 days more if it tells you why in writing, and may charge a reasonable, cost-based fee for copies. (45 CFR 160.103, “health plan”; 45 CFR 164.501, “designated record set”; 45 CFR 164.524(b)(2) and (c)(4), access and fees)
- Medicaid is a health plan under the same rule. Once you appeal to a Medicaid health plan, it must give you your case file, including medical records and any new or additional evidence, free of charge and in time before it decides. Before a state fair hearing, you may look at your case file and the documents the agency will use. (45 CFR 160.103, “health plan”; 42 CFR 438.406(b)(5), Medicaid health plan appeals; 42 CFR 431.242(a), fair hearings)
Read at the source on October 22, 2026. Your plan’s documents and notices set the rules that apply to you.
Where to send it
- Use the address for billing questions or correspondence, not the “remit to” or payment address: it is for payments, and a letter sent there may not reach the people who answer questions. If the bill gives only a payment address, call the number on the bill and ask where written questions go.
- If a collection agency has the bill, write to the address on its notice, before the date the notice gives. (CFPB rule, 12 CFR 1006.34)
- For your insurer, use the address on the denial notice or the Explanation of Benefits (EOB).
How to send it
- A message in the patient portal, or an email: free, and dated. Ask for a written answer.
- A fax: free online fax services exist. Keep the confirmation page.
- Certified Mail with an electronic return receipt, bought at a post office: $9.28 in all. That is $5.55 for Certified Mail, $2.91 for the receipt and $0.82 postage for a 1 oz letter. A paper green card costs $4.65 instead of $2.91. The receipt is proof it arrived. (USPS Notice 123, prices from October 4, 2026; USPS, Certified Mail basics)
- Certified Mail nobody collects is held at the post office for 15 days, then returned to you. USPS keeps its record for 2 years. (USPS, Certified Mail basics; USPS, tracking basics)
- A Certificate of Mailing proves the day you sent it, not that it arrived: $2.45 plus postage, $3.27 in all. (USPS Notice 123, prices from October 4, 2026)
- Keep a copy of your letter and your proof. Send copies of documents, never originals. (CMS: “Don’t mail any original documents”)
Send it so you can prove when it arrived, and keep a copy.
When the documents come
Compare the plan’s reasons with your bill and your Explanation of Benefits (EOB). The free guide What to do if the billing office says no lists the appeal steps for each kind of plan, with the usual deadline rule and where to go. How to ask the billing office and the insurer about a bill from the start: How to dispute a medical bill.
Questions about the bill itself? Open it in MedBillCheckup: it is read on your device, never uploaded, and the free check shows how many things on it are worth asking about. The full list, with the exact questions to ask, is $6.99 for one bill, or included with Pro at $9.99 a month. To ask the billing office about charges, the free medical bill dispute letter turns the ones you type into questions.
Check my bill, freeQuestions
Is this an appeal?
No. It asks for documents, and it says it is not an appeal. To appeal, follow the steps on your plan’s notice, by the date it gives: your notice sets your actual date. For job-based plans and plans you bought yourself that are not grandfathered, asking for the diagnosis and treatment codes is not, by itself, an appeal (45 CFR 147.136).
Does it cost anything?
The letter is free. A job-based plan covered by ERISA, and a plan you bought yourself that is not grandfathered (45 CFR 147.136), give the documents relevant to your claim free of charge. Under HIPAA, a health plan may charge a reasonable, cost-based fee for a copy of your records, so for Medicare, Medicaid and other plans the letter asks the plan to tell you the amount first.
How do I know whether ERISA covers my plan?
ERISA does not cover government plans, or church plans that have not chosen to be covered (29 U.S.C. 1003(b)). If your plan comes through a private employer or a union, the benefits office or the plan can tell you whether ERISA covers it. Not sure? Pick “Another plan, or not sure”: the letter then asks without naming a rule.
How long does the plan have to send the documents?
The ERISA claims rule says “upon request” and gives no number of days. Under HIPAA, a health plan acts on a request for your records within 30 days, with one 30-day extension if it tells you why in writing (45 CFR 164.524). The time to appeal counts from your plan’s notice, so keep that date in view while you wait.
What do I do when the documents come?
Compare the plan’s reasons with your bill and your Explanation of Benefits (EOB). The free guide What to do if the billing office says no lists the appeal steps for each kind of plan, with the usual deadline rule and where to go.
Is this legal advice?
No. The letter names the rule for the kind of plan you pick, from the federal texts linked on this page, and your plan’s documents and notices set the rules that apply to you. If you have Medicare, your State Health Insurance Assistance Program (SHIP) gives free counseling: find yours at shiphelp.org. For advice about your own situation, a legal aid office or a lawyer can help.
Know someone whose health plan said no to a claim?
MedBillCheckup provides informational assistance only. It does not determine whether a charge is medically necessary, fraudulent, illegal, or definitively incorrect, and it is not a substitute for advice from a lawyer, doctor, insurer, or certified medical billing specialist.