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ResourcesDenials, appeals, and what the words on your letter mean.
Plain explanations of how coverage decisions are made and how they are appealed, written for the day the letter arrives. General information, for you or someone you love, not medical or legal advice.
How to appeal a health insurance denial: a step-by-step guideWhat an appeal actually is, the two levels most people have, and how to build one: the deadline, the criteria, the evidence, the letter, and what comes after.Read the guide →What is prior authorization and why was yours denied?Prior authorization is your plan approving care before it happens. Here is what the reviewer is checking, the reasons requests get denied, and what to do when yours is.Read the guide →Step therapy: what “fail first” means and how to fight itStep therapy makes you try the plan's preferred drug before it covers the one you were prescribed. Here is what counts as a failure, what an override asks for, and how to document it.Read the guide →Formulary exceptions: getting coverage for a non-formulary drugA formulary exception asks your plan to cover a drug that is not on its list. Here is what the request has to establish, how tiering exceptions differ, and what to do when one is denied.Read the guide →How to help a family member fight an insurance denialActing for a parent, a spouse or an adult child means getting authorization first. Here is what a HIPAA release and a representative form do, what to gather, and how to hold the deadlines for someone else.Read the guide →