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Prior authorization denial

Prior authorization denied or stuck? Put a physician on it.

A licensed physician reads what your plan is actually asking for, then writes the letter that supplies it — the criteria, the records, and the urgency, in writing.

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No account needed to check. A physician tells you candidly if the case has no merit.

What this denial means

A prior-auth denial is usually a paperwork verdict, not a clinical one.

Prior authorization asks your plan to approve care before you receive it. The request is often filed by an office with minutes to spare, on a form with no room for context — so denials frequently turn on a missing chart note, an unclear code, or a criterion nobody spelled out.

The remedy is rarely to argue louder. It is to answer the specific criterion the plan applied with the specific record that satisfies it, and — when the delay itself is doing harm — to say so in the terms that trigger an expedited decision.

What the letter argues

Written by a licensed physician, cited line by line.

The exact criterion at issue

Denial letters cite a policy. The letter answers that policy on its own terms instead of restating the original request.

What the form could not hold

Chart notes, imaging, prior treatments and dates — the evidence the request assumed but never showed.

Clinical urgency, on the record

Where waiting risks harm, the letter says so explicitly and asks for expedited review, which carries far shorter deadlines.

A named recipient and a clock

The letter goes to the party you designate — your plan, the reviewing physician, a government body — and states the response window it is owed.

How Cove Health works

From a stalled authorization to a physician-signed request — in four steps.

1

Upload your records

Securely share your medical records and the denial or issue you're facing. It takes minutes.

2

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.

3

We draft & cite

Our physician drafts a rigorous advocacy letter, citing every relevant fact and healthcare guideline that supports you.

4

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.

Simple, honest pricing

One issue or many — we've got you.

Single Case
One issue, fully handled — review, drafting, and advocacy.
$100 flat fee
  • ✓ Licensed physician review of your records
  • ✓ One fully drafted, guideline-cited advocacy letter
  • ✓ Sent to the party of your choice
  • ✓ No subscription, no commitment
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Best for ongoing needs
Cove Membership
For patients juggling multiple issues across plans and providers.
$29.99 / month
  • ✓ Ongoing advocacy across multiple issues
  • ✓ Priority physician review
  • ✓ Unlimited letters while subscribed
  • ✓Continuous case tracking & follow-ups
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Cove Health provides non-legal patient advocacy. We are not a law firm and do not provide legal representation.

Frequently asked questions

Prior authorization denials, answered.

How is a prior-authorization denial different from a claim denial? +
Prior authorization happens before care; a claim denial happens after it. The practical difference is timing — with prior auth the treatment has not started yet, so an expedited appeal can matter enormously.
My doctor's office already appealed. Can you still help? +
Yes. A second, independent letter that engages the plan's stated criteria directly is often what moves a case, and it draws on records and authorities a busy office rarely has time to assemble.
What about a peer-to-peer review? +
That is a call between your treating physician and the plan's reviewer. It can help, but it is brief and leaves little trace. A written, cited letter puts the same argument on the record, where it has to be answered.
How quickly can this move? +
Expedited review exists for situations where the standard window would jeopardize your health, and it runs on much shorter deadlines. Your denial letter and plan documents state which windows apply to you.
Do you contact my insurance directly? +
Only where you authorize it. You designate the recipient of every advocacy letter — your plan, another physician, a government body, or a workplace program.

Still have a question?

Common denials

Facing a different denial?

Medical necessityYour plan called the care your physician ordered unnecessary.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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