Health Insurance Basics
Plain-language definitions of premiums, deductibles, copays, network rules, EOBs, and other terms every patient should know.
Read guideTopic
Insurance
Denials, ERISA, external review, prior authorization, appeal packets, and Medicare & Medicaid programs.
206 guides, templates, variations, and updates
Insurance 101
Start with core vocabulary, how coverage works by plan type, and how denials and prior authorization work on nearly every plan.
Choosing a Plan
Compare employer, marketplace, and public options—networks, premiums, deductibles, and prescription coverage before you enroll.
Read guideDenial Decoder
What denials mean in plain language, common CO and PR codes, and practical next steps for appeals and corrected claims.
Read guideHow Coverage Works by Plan Type
Private employer, marketplace, and self-funded models—and how they differ from Medicare and Medicaid.
Read guideAppeal a denial
Roadmaps and tactics for appealing a denial, escalating urgent cases, and involving regulators when the plan will not budge.
Appeals Roadmap
What to do when a health insurance claim is denied—read the letter, gather records, file an internal appeal, and escalate if needed.
Read guideComplaints to Regulators
When to contact a state insurance department, Department of Labor, CMS, Medicaid agency, or attorney general.
Read guideBuilding a Strong Appeal Packet
Medical records, letters of medical necessity, guidelines, peer-reviewed evidence, timelines, and patient impact statements.
Read guidePlan types
How private coverage works—employer, marketplace, and self-funded models—and who regulates each.
Employer Plans
Job-based coverage, fully insured vs self-funded, ERISA basics, regulators, and what to do when coverage is denied.
Read guideMarketplace Plans
ACA exchange coverage, federal and state oversight, essential health benefits, and resolving denials and enrollment issues.
Read guideSelf-Funded ERISA Plans
What ERISA self-funded plans are, how they differ from fully insured coverage, and how to appeal denials and build a strong record.
Read guideMedicare & medicaid programs
Original Medicare, Part D, Medicaid managed care, fee-for-service Medicaid, eligibility, and dual coverage.
Browse guidesState insurers & legislation
State-specific regulators, laws, carrier links, and appeal deadlines.
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- Connecticut
- Delaware
- District of Columbia
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming