The short answer
Prior auth denials are usually clinical judgments by a medical director. Request a peer-to-peer within 72 hours — your doctor talks directly to the insurer's reviewer. If that fails, file a formal internal appeal within 180 days, then external review by an IRO (binding, free). Cite the plan's own medical necessity criteria.
Frequently asked
- Can I get an expedited decision?
- Yes — if delay would jeopardize health, request expedited review (72 hours).
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