Appeal by denial reason
The reason on your denial letter determines the evidence that overturns it. Pick yours for the playbook.
Not medically necessary
The insurer agrees the service exists in your plan but says your specific case does not meet their clinical criteria.
Experimental or investigational
The insurer says the treatment is not yet proven for your condition and is therefore excluded.
Out of network
The provider does not have a contract with your insurer, so the claim was paid at a lower rate or not at all.
Prior authorization required
The insurer required pre-approval that was not obtained before the service.
Step therapy required
The insurer requires you to try a preferred lower-cost drug or service before approving the requested one.
Lack of documentation
The insurer says the records submitted did not support the claim.
MRI denied
The insurer says the MRI was not authorized or did not meet criteria.
CT scan denied
The insurer says the CT was not medically necessary or not authorized.
Bariatric surgery denied
The insurer denied weight-loss surgery despite documented obesity.
Mental health treatment denied
The insurer denied inpatient, IOP, PHP, or outpatient mental health care.
Physical therapy visits denied
The insurer cut off PT visits before the plan limit or denied additional sessions.
Infertility or IVF denied
The insurer denied fertility evaluation or treatment.
Genetic testing denied
The insurer denied a genetic test as not medically necessary or experimental.
ER visit denied
The insurer denied an emergency room claim, often citing 'not an emergency.'
Durable medical equipment denied
The insurer denied equipment like CPAP, wheelchair, or insulin pump.
Not sure which reason applies?
Upload the denial letter. The free analysis identifies the cited reason and the evidence that overturns it.
Not legal or medical advice. This page is a self-help resource. You make your own decisions. Strip personal identifiers (name, date of birth, address, member ID) from any document before uploading or sharing. The information here summarizes commonly-published payer policies and federal rules; confirm against your specific plan document and the current denial letter before acting.