Health sharing plans deny claims for three main reasons: the expense isn't a covered "eligible need," a pre-existing condition waiting period applies, or the documentation is incomplete. Unlike insurance, you have no state insurance commissioner to appeal to — but every major plan has an internal appeals process, and many denials get reversed on appeal with the right documentation. Here's exactly what to do.

Why Health Sharing Plans Deny Claims

Before you appeal, you need to know why the claim was denied. The denial letter will state a reason — and the reason determines your strategy.

The 5 Most Common Denial Reasons

1. Pre-Existing Condition Waiting Period

Most plans have waiting periods before they'll share costs related to conditions you had before joining:

• Medi-Share: 12-36 months depending on condition
• CHM: 12 months (Gold level), 3 years (Bronze/Silver for some conditions)
• Samaritan Ministries: Varies by condition — some never covered
• Zion HealthShare: No waiting period for most conditions (major exception among major plans)
• Sedera: Varies by condition, 12-month typical

Strategy: If this is the reason, check your membership start date against the incident date. If you've passed the waiting period and the plan is still denying, appeal with documented evidence of your membership start date and the date of service.

2. Expense Is Not an Eligible Need

Health sharing plans only share "eligible needs" — defined differently by each plan. Common excluded categories:

• Preventive care (most plans)
• Routine dental and vision
• Birth control and contraceptives
• Cosmetic procedures
• Mental health (some plans)
• Chiropractic (limited coverage on most plans)
• Experimental treatments
• Substance abuse treatment (some plans)

Strategy: If the expense was genuinely excluded, an appeal is unlikely to succeed. Your energy is better spent negotiating a cash-pay rate with the provider directly — which is often 40-60% below billed rates.

3. Incomplete or Incorrect Documentation

This is the most winnable denial reason. Plans require specific documentation to process claims:

• Itemized bill (not just the EOB)
• Medical records showing the diagnosis code (ICD-10)
• Doctor's notes explaining medical necessity
• Proof of payment if you've already paid

Strategy: Gather every piece of documentation and resubmit. These denials reverse at a high rate when documentation is complete.

4. Provider Is Not in Network (for Network-Required Plans)

Zion uses Cigna's network. If you saw an out-of-network provider, costs may be shared at a reduced rate or denied entirely for non-emergency care.

Strategy: For future care, always verify network status. For an existing denial, appeal by documenting that the out-of-network provider was the only reasonable option (geographic necessity, specialist unavailability, emergency).

5. Amount Exceeds Annual Household Portion (AHP / IUA)

Each plan has an annual household portion — the amount you pay before sharing kicks in. If your claim is below your AHP, it's not a denial — it's working as designed.

Strategy: Track your cumulative out-of-pocket costs toward your AHP. Once hit, subsequent eligible claims should be fully shared.

Step-by-Step: How to Appeal a Denied Claim

Step 1: Read the Denial Letter Carefully

The letter will include:

• Specific denial reason (often a code)
• The expense or service denied
• The appeal deadline (typically 30-60 days from denial date)
• Instructions for submitting an appeal

Don't miss the deadline. Missing it forfeits your appeal rights.

Step 2: Gather Your Documentation

Collect everything before writing a single word:

| Document | Where to Get It | |----------|----------------| | Original claim form | Your member portal | | Itemized bill from provider | Call billing department, ask specifically for "itemized statement" | | Medical records | Your doctor's office (may take 7-14 days) | | Doctor's letter of medical necessity | Request from your doctor — explain you're appealing a health sharing denial | | Denial letter | Your member portal or mail | | Proof of membership | Member ID card + start date | | Prior authorization (if required) | Your records |

Step 3: Write Your Appeal Letter

Keep it factual, not emotional. Include:

1. Your member ID and the claim number
2. The date of service and the provider
3. The denial reason (quote it from the letter)
4. Why the denial is incorrect (specific, documented)
5. What you're requesting (full sharing, partial sharing, reconsideration)
6. A list of all documents attached

Template:

Dear [Plan Name] Appeals Department,

I am writing to appeal the denial of claim [CLAIM NUMBER] dated [DATE], for services rendered on [DATE OF SERVICE] by [PROVIDER NAME].

The denial reason stated was: [EXACT QUOTE FROM DENIAL LETTER].

I am requesting reconsideration for the following reasons:

[Your specific reasons — e.g., "The waiting period for this condition ended on [DATE], three months before the date of service. Attached is documentation of my membership start date and the medical records confirming when this condition was first diagnosed."]

I have attached the following documentation: [list everything]

Please confirm receipt of this appeal and advise on your timeline for review.

Sincerely, [Your Name] Member ID: [XXXXXXX]

Step 4: Submit via Certified Methods

Don't just email. Submit through:

• Member portal (creates a timestamp)
• Certified mail (creates legal proof of receipt)
• Both if the denial involves significant money

Keep copies of everything.

Step 5: Follow Up

Each plan has a response timeline — typically 30-60 days. If you don't hear back:

• Call the member services line and ask for your appeal status
• Reference your submission date and confirmation number
• Ask for a specific response date

Plan-Specific Appeal Processes

Medi-Share

• Appeal window: 60 days from denial
• Process: Submit via member portal or mail to Medi-Share Appeals, PO Box 1847, Melbourne FL 32902
• Escalation: Request a "Consultant Review" if initial appeal is denied
• Notable: Medi-Share has a formal peer review process where medical professionals review disputes

CHM (Christian Healthcare Ministries)

• Appeal window: 30 days from denial
• Process: Written appeal to memberservices@chministries.org
• Escalation: Request review by CHM's "Guidelines Committee"
• Notable: CHM's Bronze and Silver levels have more restricted sharing — many denials on lower tiers are simply ineligible on those levels. Gold members have broader sharing.

Samaritan Ministries

• Appeal window: Varies — contact member services immediately
• Process: Call member services first, then submit written documentation
• Notable: Samaritan uses a "Special Prayer Needs" category for needs that fall outside normal guidelines — worth requesting consideration for unusual situations

Zion HealthShare

• Appeal window: 90 days
• Process: Submit via member portal or email to memberservices@zionhealthshare.org
• Notable: Zion's no-waiting-period policy means most pre-existing condition denials shouldn't happen — if you get one, it may be a processing error worth escalating

Sedera

• Appeal window: 60 days
• Process: Submit written appeal through member portal
• Notable: Sedera operates more transparently than most — their guidelines are publicly available so you can verify whether your expense qualifies before appealing

What Happens if the Appeal Fails?

If the plan upholds the denial, your remaining options:

1. Negotiate directly with the provider

Most hospitals and medical practices will negotiate cash-pay rates. Tell them your sharing plan denied the claim and ask for their self-pay rate. Common results:

• Hospital bills: 40-60% reduction
• Specialist bills: 20-40% reduction
• Lab work: Often 50-80% reduction

2. Request a payment plan

Medical providers are required to offer payment plans under federal law. A $10,000 bill paid at $200/month is manageable even if never shared.

3. Request charity care

Most nonprofit hospitals have charity care programs for patients below certain income thresholds. Even if you don't qualify for free care, partial assistance is common.

4. Review for billing errors

Medical billing error rates are high — estimates range from 30-80% of bills containing errors. Request an itemized bill and review every line. Common errors include duplicate charges, upcoding, and charges for services not received.

5. Consider a patient advocate

Professional patient advocates negotiate medical bills on your behalf, often for a percentage of savings. Worth considering for bills over $5,000.

How to Avoid Claim Denials in the Future

1. Pre-authorize expensive services

Call your plan before any procedure over $500 and ask:

• Is this service eligible for sharing?
• Do I need pre-authorization?
• What documentation will I need to submit?

This conversation creates a paper trail that strengthens any future appeal.

2. Understand your plan's guidelines

Every major plan publishes its member guidelines — read the section on eligible needs before you need it, not after.

3. Submit claims promptly

Most plans have claim submission windows (often 90-180 days from date of service). Miss the window and the claim is automatically ineligible.

4. Use in-network providers for network plans

For Zion (Cigna network) and Presidio, verify network status before every appointment using the plan's online provider lookup tool.

5. Document everything

Keep copies of every medical bill, every explanation of benefits, every claim you submit, and every communication with your plan. If you ever need to appeal, documentation is the difference between winning and losing.

The Bottom Line

Claim denials feel like a dead end, but they often aren't. The most common reason — incomplete documentation — reverses frequently when you submit the right paperwork. Pre-existing condition denials require checking your waiting period timeline. Ineligible expense denials are harder to overturn but worth reviewing the guidelines carefully before giving up.

The key is acting quickly (most plans have 30-60 day appeal windows), documenting thoroughly, and keeping your appeal factual and specific.

If you're evaluating health sharing plans and worried about claim denials, Zion HealthShare's no-waiting-period policy and Medi-Share's formal peer review process are both worth considering.

Related: How Health Sharing Plans Work | Pre-Existing Conditions Guide | Compare All Plans