Insurance Denied Prior Authorization: What To Do

Insurance denials for a prior authorization request often involve missing clinical criteria, plan rules, incomplete records, medical necessity review, or a requirement to try another treatment first. The most important first step is to read the denial letter carefully and identify the specific reason the insurer gave.

Helpful documents may include provider notes, diagnosis records, treatment history, the requested service, and documentation showing why the provider requested authorization. If the denial letter says information was missing, include the missing information with the appeal whenever possible.

A clear appeal letter should identify the patient, insurer, member ID, claim number, denied prior authorization request, denial reason, and request for reconsideration. It should explain that the treating provider recommended the care and list the records attached for review.

Keep the tone factual and professional. The goal is to make it easy for the insurer to understand what was denied, why you disagree, and what documents support another review.

ClaimFighter includes a prior authorization denial category. You can upload the denial letter, confirm extracted details, select the category, and generate an editable appeal draft that you can review and download.