A specific type of service required your insurer approval before it was performed, and your provider did not get it.
Ask your provider whether they attempted to obtain authorization. If they did, request proof and have them resubmit. If no authorization was attempted, appeal on the grounds of medical urgency or emergency if applicable.
Appeal outlook: Moderate for emergency situations
Recommended tool
Bill Advantage can analyze your denial and generate a ready-to-send appeal or dispute letter in minutes.
Open Prior Authorization Appeal GeneratorDenial codes on your EOB explain why a claim was denied. Learn what the most common codes mean in 2026 and the exact steps to fix or appeal each one.
Read articleWhat to Do When Insurance Denies a ClaimInsurance denied your claim? Learn the exact steps to appeal a health insurance denial in 2026, from reading the denial letter to external independent review.
Read article