The denial reason determines what to do next
Common denial reasons include a service deemed not medically necessary, a missing prior authorization, an out-of-network provider, or a billing code error -- the right next step depends heavily on which one applies.
Most plans offer two levels of appeal
An internal appeal is reviewed by the insurance company itself, generally within a set number of days. If that doesn't resolve the issue, many plans and states also offer an external review by an independent third party.
- Deadlines for both levels are generally strict and worth confirming immediately
- Your state insurance department can often help if you're stuck mid-process