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Common denial types

The denials we take on, and what each one means.

Plans refuse care in a handful of recognisable ways. Find the one that matches the letter you are holding, then read what an appeal has to show. General information, for you or someone you love, not medical or legal advice.

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Which of these matches your letter?

Medical necessityYour plan called the care your physician ordered unnecessary.What we do about it →Prior authorizationYour plan wants to approve the care before it happens, and has not.What we do about it →Step therapyYour plan wants you to fail on a cheaper drug first.What we do about it →Formulary exceptionYour drug is off your plan's list, or on a tier you cannot afford.What we do about it →
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Guides by drug category.

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