US Medical Term · insurance
Appeal
Apelación
What it means
An appeal is a request for your health insurance company or the Health Insurance Marketplace to review a decision that denies a benefit or payment. If your health plan refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party. HealthCare.gov describes 2 ways to appeal a health plan decision. In an internal appeal, you ask your insurance company to conduct a full and fair review of its decision. In an external review, you take your appeal to an independent third party, so the insurance company no longer gets the final say over whether to pay a claim. Small businesses can also appeal Small Business Health Options Program (SHOP) decisions.
Appeal in Spanish
- Spanish term
- Apelación
- Gender and article
- feminine: la apelación
- Pronunciation
- ah-peh-lah-SYOHN
Apelación is the headword of the CuidadoDeSalud.gov glossary entry that matches the HealthCare.gov entry "Appeal"; it is defined there as una solicitud para que su compañía de seguros médicos o el Mercado de Seguros Médicos revisen una decisión que niega un beneficio o pago. The Spanish dictionary marks apelación as a feminine noun and a legal term, defined as the action of appealing (acción de apelar). The verb is apelar: the glossary writes presentar una apelación for "file an appeal" and apelar la decisión for "appeal the decision."
CuidadoDeSalud.gov names the two routes apelación interna (internal appeal) and revisión externa (external review), and words the right as tiene derecho a apelar la decisión de la compañía y hacer que un tercero la revise. The same site translates "claim" two ways: the glossary entry says reclamación, and the how-to page says reclamo. The dictionary lists recurso among the synonyms or related words of apelación.
Phrases for an appointment
What a patient or a clinician might say, in English and Spanish:
| Who | English | Spanish |
|---|---|---|
| Patient | My health plan refused to pay the claim for my surgery. Can I appeal the decision? | Mi plan de salud se negó a pagar la reclamación de mi cirugía. ¿Puedo apelar la decisión? |
| Clinician | Yes. You have the right to appeal the decision and have it reviewed by a third party. | Sí. Usted tiene derecho a apelar la decisión y hacer que un tercero la revise. |
| Patient | How do I file an appeal? | ¿Cómo presento una apelación? |
| Clinician | Did the insurance company tell you why it denied the claim? | ¿La compañía de seguros le dijo por qué rechazó la reclamación? |
| Patient | Yes, I brought the letter. Could you help me understand it? | Sí, traje la carta. ¿Me podría ayudar a entenderla? |
| Clinician | First you ask the insurance company for an internal appeal. | Primero usted le pide a la compañía de seguros una apelación interna. |
| Patient | And if the company says no again, what can I do? | Y si la compañía vuelve a decir que no, ¿qué puedo hacer? |
| Clinician | Then you can ask for an external review by an independent third party. | Entonces puede pedir una revisión externa por un tercero independiente. |
In 9 languages
| Language | Term |
|---|---|
| English | Appeal |
| Spanish (Español) | Apelación |
| Chinese (中文) | 申诉 |
| Korean (한국어) | 이의 신청 |
| Vietnamese (Tiếng Việt) | Kháng cáo |
| Filipino (Tagalog) | Apela |
| Portuguese (Português) | Recurso |
| Thai (ภาษาไทย) | การอุทธรณ์ |
| Japanese (日本語) | 不服申し立て |
Where you'll see it
Related terms
Your right to an interpreter in the United States
If English is not your primary language and you have difficulty communicating in English, you may need an interpreter or a translated document when you visit a doctor or dentist, go to the emergency room or pick up a prescription. The U.S. Department of Health and Human Services Office for Civil Rights states that two federal laws, Title VI of the Civil Rights Act of 1964 and Section 1557 of the Affordable Care Act, require programs that receive its funding to provide language access services free of charge.
You can ask when you make the appointment or at the front desk: "I need an interpreter, please." «Necesito un intérprete, por favor.»
More terms: Insurance and billing
All terms in this area: Insurance and billing — Seguro médico y facturación
Sources
- Appeal - Glossary — HealthCare.gov, Centers for Medicare & Medicaid Services (CMS)
- Apelación - Glosario — CuidadoDeSalud.gov, Centros de Servicios de Medicare y Medicaid (CMS)
- How to appeal an insurance company decision — HealthCare.gov, Centers for Medicare & Medicaid Services (CMS)
- Cómo apelar una decisión de la compañía de seguros — CuidadoDeSalud.gov, Centros de Servicios de Medicare y Medicaid (CMS)
- apelación — Diccionario de la lengua española — Real Academia Española / ASALE
- Limited English Proficiency (LEP): Your Right to Language Assistance Services — U.S. Department of Health and Human Services, Office for Civil Rights
This page is a language reference. It is not medical advice.
Last reviewed: October 8, 2026