Denied as “not medically necessary”? A physician can answer that.
A licensed physician reads your records, decides whether your case has merit, and writes the letter that answers your plan on its own clinical terms.
No account needed to check. A physician tells you candidly if the case has no merit.
“Not medically necessary” is an opinion — and opinions can be answered.
When a plan denies care as not medically necessary, it is saying its written criteria were not met by the paperwork in front of it. That paperwork is usually a fraction of your chart: a claim form, a code, perhaps a short note. The reviewer rarely sees how your illness has moved, what you have already tried, or why your treating physician chose this option.
That gap is where an appeal does its work. Your plan's criteria are written down, and so is the clinical evidence behind your treatment. Setting the two side by side, in the plan's own language, is work that takes a clinician — which is exactly who Cove Health puts on your case.
Written by a licensed physician, cited line by line.
Your record, in full
The history the reviewer never saw: diagnoses, prior treatments and how each one turned out, and the way the condition has progressed.
The plan's own criteria
Your plan publishes the medical-necessity criteria it applied. The letter walks them point by point and shows where your case meets them.
Guidelines and evidence
Specialty-society guidelines, labeling and peer-reviewed literature supporting the treatment your physician ordered — each cited, so nothing rests on assertion.
Why the alternative does not fit
Where the plan points to a cheaper or more conservative option, the letter explains clinically why it is not appropriate for you.
From your denial letter to a physician-signed appeal — in four steps.
Upload your records
Securely share your medical records and the denial or issue you're facing. It takes minutes.
We review the merit
A licensed physician evaluates your case. If it has merit, we move forward — and you tell us who to contact on your behalf.
We draft & cite
Our physician drafts a rigorous advocacy letter, citing every relevant fact and healthcare guideline that supports you.
We advocate
The letter goes to the party you designate — your plan, another physician, a government body, or a workplace program — making your case in writing.
One issue or many — we've got you.
- ✓ Licensed physician review of your records
- ✓ One fully drafted, guideline-cited advocacy letter
- ✓ Sent to the party of your choice
- ✓ No subscription, no commitment
- ✓ Ongoing advocacy across multiple issues
- ✓ Priority physician review
- ✓ Unlimited letters while subscribed
- ✓Continuous case tracking & follow-ups
Cove Health provides non-legal patient advocacy. We are not a law firm and do not provide legal representation.
Medical necessity denials, answered.
What does “not medically necessary” actually mean on my denial? +
Can a medical necessity denial be appealed? +
Does Cove Health replace my doctor? +
What if my case does not have merit? +
How quickly do I need to act? +
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