A complete fillable workbook for a health insurance denial or surprise medical bill: case intake, denial decoder, evidence checklist, call log, itemized-bill request, three appeal letters, external review, charity-care request, and a collections letter.

This edition is sourced. Section 12 cites 175 primary authorities — ERISA and ACA appeal rules, the No Surprises Act, Medicare and Medicaid paths, hospital 501® financial assistance, HIPAA record access, and FDCPA validation — so every template sits on a named statute, regulation, or study.

Print it. Fill it. Send it. Keep the copies.

This is an educational organizing kit — not legal, medical, or insurance advice. Deadlines come from your denial letter and plan documents.