Understanding Insurance Denials
Insurance companies deny claims for many reasons, but most denials fall into a few main categories. Understanding why your claim was denied is the first step to a successful appeal. Explore the most common denial types below to learn specific strategies for your situation.
Once you identify your denial type, follow our step-by-step appeal process and use the free appeal letter builder to get started. See the statistics on why appealing works.
Prior Authorization
Your insurer requires pre-approval for a service, and either it was not obtained or the request was denied.
Experimental Treatment
The insurer deems a treatment or drug investigational, even if it is standard care for your condition.
Emergency Room
Your claim for an ER visit is denied retroactively because the insurer decided it was not a true emergency.
Out-of-Network
You received care from a provider or facility that is not in your plan's network, often unknowingly.
Step Therapy
The insurer requires you to try and fail on a cheaper drug before they will cover the one you were prescribed.