MRI denied: how to appeal
The insurer says the MRI was not authorized or did not meet criteria. Documented 4 to 6 weeks of conservative therapy.
Why this denial happens
- Conservative therapy not documented
- X-ray or other imaging not done first
- Symptoms not severe enough per policy
What overturns it
- Documented 4 to 6 weeks of conservative therapy
- Red-flag symptoms (neurologic deficit, suspected fracture, suspected malignancy)
- Specialist referral
Evidence checklist
- ✓PT or chiropractic notes
- ✓Neurologic exam findings
- ✓Prior X-ray report
- ✓Specialist letter
Most plans require documented conservative therapy before an outpatient MSK MRI unless red-flag symptoms are present.
Draft an appeal for a "MRI" denial
Free analysis identifies the cited policy and missing evidence. Then a finished letter.
FAQ
What does "MRI denied" mean on a denial letter?+
The insurer says the MRI was not authorized or did not meet criteria.
How long do I have to appeal?+
180 days from the date of denial for ERISA group plans and ACA marketplace plans. 60 days for Medicare Advantage. Check the denial letter for your specific deadline.
What is the success rate for this kind of appeal?+
Outcomes vary, but medical-necessity and step-therapy appeals overturn at meaningful rates when the appeal cites the insurer's own policy and the chart documents the required criteria.
Other denial reasons
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.